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Scott W. Cheatham

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented. Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States. Design: Cross-sectional descriptive survey study. Methods: A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education. Results: One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research. Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

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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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Scott W. Cheatham and Kyle R. Stull

Context: Roller massage (RM) is a popular myofascial intervention. To date, no research has investigated the effects of RM on experienced and nonexperienced individuals and if there are differences between a prescribed RM program and a self-preferred program. Objective: The main objective was to measure the effects of a prescribed RM program with a foam roller on knee passive range of motion (ROM) and pressure pain threshold (PPT) among experienced and nonexperienced individuals. A secondary objective was to determine if there are differences between a prescribed RM program and a self-preferred program in experienced individuals. Design: Pretest and posttest observational study. Setting: University kinesiology laboratory. Participants: A total of 60 healthy adults (age = 26 [5.3] y) were allocated into 3 groups of 20 subjects: experienced, nonexperienced, and control. The experienced and nonexperienced groups followed a prescribed 2-minute RM intervention. The control group did their own 2-minute self-preferred program. Main Outcome Measures: Knee passive ROM and PPT. Results: For the experienced and nonexperienced, the between-group analysis revealed a statistically significant difference for ROM and PPT (P < .001). Within-group analysis revealed a posttest knee passive ROM increase of 8° for experienced and 7° for the nonexperienced. For PPT, there was a posttest increase of 180 kPa for the experienced and 169 kPa for the nonexperienced. For the prescribed versus self-preferred program, the between-group analysis (experienced vs control) revealed a statistically significant difference (P < .001). The within-group analysis revealed a posttest knee passive ROM increase of 8° for the prescribed and 5° for the self-preferred program. For PPT, there was a posttest increase of 180 kPa for the prescribed program and 137 kPa for the self-preferred program. Conclusion: These findings suggest that experienced and nonexperienced individuals have similar responses to a prescribed RM program. A prescribed RM program may produce better outcomes than a self-preferred program.

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Scott W. Cheatham and Morey J. Kolber

Context: Foam rolling is a popular intervention used by allied health professionals and the general population. Current research suggests that foam rolling may have an effect on the ipsilateral antagonist muscle group and produce a cross-over effect in the muscles of the contralateral limb. The purpose of this study was to examine the acute effects of foam rolling to the left quadriceps on ipsilateral antagonist hamstrings and contralateral quadriceps muscle group pressure pain threshold (PPT). Through this research, we sought to gather data to further develop the methodology for future studies of this intervention. Design: A pretest–posttest exploratory study. Setting: University kinesiology laboratory. Participants: 21 healthy adults (age = 27.52 ± 8.9 y). Intervention: Video-guided foam roll intervention on the left quadriceps musculature. Main Outcome Measures: Ipsilateral hamstring (antagonist) and contralateral quadriceps muscle PPT. Results: A significant difference was found between pretest to posttest measures for the ipsilateral hamstrings (t[20] = −6.2, P < 0.001) and contralateral quadriceps (t[20] = −9.1, P < 0.001) suggesting an increase in PPT. Conclusions: These findings suggest that foam rolling of the quadriceps musculature may have an acute effect on the PPT of the ipsilateral hamstrings and contralateral quadriceps muscles. Clinicians should consider these results to be exploratory and future investigations examining this intervention on PPT is warranted.

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Scott W. Cheatham, Kyle R. Stull and Morey J. Kolber

Background: Roller massage (RM) has become a common intervention among health and fitness professionals. Recently, manufacturers have merged the science of vibration therapy and RM with the development of vibration rollers. Of interest, is the therapeutic effects of such RM devices. Purpose: The purpose of this study was to compare the effects of a vibration roller and nonvibration roller intervention on prone knee-flexion passive range of motion (ROM) and pressure pain threshold (PPT) of the quadriceps musculature. Methods: Forty-five recreationally active adults were randomly allocated to one of 3 groups: vibration roller, nonvibration roller, and control. Each roller intervention lasted a total of 2 minutes. The control group did not roll. Dependent variables included prone knee-flexion ROM and PPT measures. Statistical analysis included parametric and nonparametric tests to measure changes among groups. Results: The vibration roller demonstrated the greatest increase in PPT (180 kPa, P < .001), followed by the nonvibration roller (112 kPa, P < .001) and control (61 kPa, P < .001). For knee flexion ROM, the vibration roller demonstrated the greatest increase in ROM (7°, P < .001), followed by the nonvibration roller (5°, P < .001) and control (2°, P < .001). Between groups, there was a significant difference in PPT between the vibration and nonvibration roller (P = .03) and vibration roller and control (P < .001). There was also a significant difference between the nonvibration roller and control (P < .001). For knee ROM, there was no significant difference between the vibration and nonvibration roller (P = .31). A significant difference was found between the vibration roller and control group (P < .001) and nonvibration roller and control group (P < .001). Conclusion: The results suggest that a vibration roller may increase an individual’s tolerance to pain greater than a nonvibration roller. This investigation should be considered a starting point for future research on this technology.

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Scott W. Cheatham, Morey J. Kolber and Kathryn Kumagai Shimamura

Clinical Scenario:

The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis.

Focused Clinical Question:

Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation?

Summary of Key Findings:

Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6–48 mo for all patients.

Clinical Bottom Line:

There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation.

Strength of Recommendation:

There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

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Scott W. Cheatham, Morey J. Kolber and Michael P. Ernst

Context:

Pulse rate is commonly measured manually or with commercial wrist or belt monitors. More recently, pulse-rate monitoring has become convenient with the use of mobile technology that allows monitoring through a smartphone camera. This optical technology offers many benefits, although the clinimetric properties have not been extensively studied.

Design:

Observational study of reliability.

Setting:

University kinesiology laboratory.

Participants:

30 healthy, recreationally active adults.

Intervention:

Concurrent measurement of pulse rate using 2 smartphone applications (fingertip, face-scan,) with the Polar H7 belt and pulse oximeter.

Main Outcome Measure:

Average resting pulse rate for 5 min in 3 positions (supine, sitting, and prone).

Results:

Concurrent validity in supine and standing was good between the 2 applications and the Polar H7 (intraclass correlation coefficient [ICC] .80–.98) and pulse oximeter (ICC .82–98). For sitting, the validity was good between the fingertip application, Polar H7 (ICC .97), and pulse oximeter (ICC .97). The face-scan application had moderate validity with the Polar H7 (ICC .74) and pulse oximeter (ICC .69). The minimal detectable change (MDC90) between the fingertip application and Polar H7 ranged from 1.38 to 4.36 beats/min (BPM) and from 0.69 to 2.97 BPM for the pulse oximeter with both positions. The MDC90 between the face-scan application and Polar H7 ranged from 11.88 to 12.83 BPM and from 0.59 to 17.72 BPM for the pulse oximeter. The 95% limits of agreement suggest that the fingertip application may vary between 2.40 and 3.59 BPM with the Polar H7 and between 3.40 and 3.42 BPM with the pulse oximeter. The face-scan application may vary between 3.46 and 3.52 BPM with the Polar H7 and between 2.54 and 3.46 BPM with the pulse oximeter.

Conclusion:

Pulse-rate measurements may be effective using a fingertip application, belt monitor, and pulse oximeter. The fingertip scanner showed superior results compared with the face scanner, which only demonstrated modest validity compared with the Polar H7 and pulse oximeter.

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Scott W. Cheatham, Keelan R. Enseki and Morey J. Kolber

Context:

Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.

Objective:

To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.

Evidence Acquisition:

A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.

Evidence Synthesis:

Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.

Conclusion:

This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

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Scott W. Cheatham, Kyle R. Stull, Mike Fantigrassi and Ian Montel

Context: The squat is a fundamental movement for weightlifting and sports performance. Both unilateral and bilateral squats are also used to assess transitional and dynamic lower-extremity control. Common lower-extremity conditions can have an influence on squat performance. Of interest are the effects of hip musculoskeletal conditions and associated factors, such as hip muscle pain, fatigue, and tightness, on squat performance. Currently, there has been no appraisal of the evidence regarding the association of these conditions and associated factors on squat performance. Objective: This study evaluated the current evidence regarding common hip musculoskeletal conditions and associated factors, such as hip muscle pain, fatigue, and tightness, on squat performance. Evidence Acquisition: A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar® was conducted in October, 2016 using the following keywords alone and in combination: hip, joint, arthritis, pain, range of motion (ROM), fatigue, tightness, pathology, condition, muscle, intraarticular, extraarticular, femoroacetabular impingement, single leg, bilateral, squat, performance, and technique. The grading of studies was conducted using the Physiotherapy Evidence Database scale. Evidence Synthesis: The authors identified 35 citations, 15 of which met the inclusion criteria. The qualifying studies yielded a total of 542 subjects (160 men and 382 women; mean age = 29.3 (5.9) y) and measured performance with either the barbell squat, step down, bilateral, or single-leg squat. Femoroacetabular impingement and hip arthroscopy were the only hip conditions found that affected the squat. Associated factors, such as muscle pain, fatigue, and tightness, also influenced squat performance. Conclusion: This review found that common hip conditions and associated factors and their effects on squat performance to be underinvestigated. Future research should focus on the association between common hip conditions and squat performance.

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Scott W. Cheatham, Keelan R. Enseki and Morey J. Kolber