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Paul R. Geisler and Todd Lazenby

Clinical practice in sports medicine is often guided by axioms or paradigms of practice, some of which have persisted over time despite a lack of objective evidence to support their validity. Evidence-based practice compels practicing clinicians to not only seek out and produce evidence that informs their decision-making, but also to challenge existing paradigms of thought and practice, especially when favorable treatment outcomes remain elusive. Insidious, load induced lateral knee pain around the iliotibial band in runners, cyclists, military personnel, rowers, and other athletes has for decades now been conceptualized as iliotibial band friction syndrome, a biomechanically based and unsubstantiated paradigm based on Renne’s 1975 theory that the iliotibial band slips back and forth over the lateral femoral epicondyle during flexion and extension movements of the knee, primarily irritating the underlying bursa and even the iliotibial band itself. Newer evidence about the anatomy and biomechanics of the iliotibial band, the physiology of the condition, and interventional outcomes is now available to challenge that long-held paradigm of thought for iliotibial band related pathology. Given this plethora of new information available for clinical scientists, iliotibial band impingement syndrome is proposed here as a new, evidence-informed paradigm for evaluating and treating this problematic overuse syndrome.

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Francis M. Kozub and Christoph Lienert

This review explores the known literature with respect to attitudes and introduces a criterion paradigm to aid future researchers in studying links to attitude behavior. Prior writing has varied from a more atheoretical study of attitude behavior to a focus using theories from other disciplines, most notably the theory of planned behavior (Ajzen, 1985). The premise of this paper is that attitude study should progress beyond basic description regarding profiles of pre and inservice teachers to the study of teacher and learner behaviors as a function of known attitude profiles and other mediating variables.

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Justin A. Haegele and Samuel Russell Hodge

There are basic philosophical and paradigmatic assumptions that guide scholarly research endeavors, including the methods used and the types of questions asked. Through this article, kinesiology faculty and students with interests in adapted physical activity are encouraged to understand the basic assumptions of applied behavior analysis (ABA) methodology for conducting, analyzing, and presenting research of high quality in this paradigm. The purposes of this viewpoint paper are to present information fundamental to understanding the assumptions undergirding research methodology in ABA, describe key aspects of single-subject research designs, and discuss common research designs and data-analysis strategies used in single-subject studies.

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Cui Zhang, Qipeng Song, Wei Sun and Yu Liu

cognitive attention ( Yogev, Hausdorff, & Giladi, 2008 ) and executive functions ( Hausdorff, Yogev, Springer, Simon, & Giladi, 2005 ) of the brain in older adults. The dual-task paradigm/condition is typically used to describe a person who is performing a primary task while carrying out a concurrent

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Andrew P. Winterstein and Tim McGuine

Column-editor : Patrick Sexton

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Luke M. Ross, Johna K. Register-Mihalik, Jason P. Mihalik, Karen L. McCulloch, William E. Prentice, Edgar W. Shields and Kevin M. Guskiewicz

Context:

Recent evidence has revealed deficiencies in the ability to divide attention after concussion.

Objective:

To examine the effects of a single vs a dual task on cognition and balance in healthy subjects and to examine reliability of 2 dual-task paradigms while examining the overall feasibility of the tasks.

Design:

Pretest–posttest experimental design.

Setting:

Sports medicine research laboratory.

Patients:

30 healthy, recreationally active college students.

Intervention:

Subjects performed balance and cognitive tasks under the single- and dual-task conditions during 2 test sessions 14 d apart.

Main Outcome Measures:

The procedural reaction-time (PRT) test of the Automated Neuropsychological Assessment Metrics (eyes-closed tasks) and an adapted Procedural Auditory Task (PAT; eyes-open tasks) were used to assess cognition. The NeuroCom Sensory Organization Test (SOT) and the Balance Error Scoring System (BESS) were used to assess balance performance. Five 2-way, within-subject ANOVAs and a paired-samples t test were used to analyze the data. ICCs were used to assess reliability across 2 test sessions.

Results:

On the SOT, performance significantly improved between test sessions (F 1,29 = 35.695, P < .001) and from the single to the dual task (F 1,29 = 9.604, P = .004). On the PRT, performance significantly improved between test sessions (F 1,29 = 57.252, P < .001) and from the single to the dual task (F 1,29 = 7.673, P = .010). No differences were seen on the BESS and the PAT. Reliability across test sessions ranged from moderate to poor for outcome measure.

Conclusions:

The BESS appears to be a more reliable and functional tool in dual-task conditions as a result of its increased reliability and clinical applicability. In addition, the BESS is more readily available to clinicians than the SOT.

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Maria K. Talarico, Robert C. Lynall, Timothy C. Mauntel, Erin B. Wasserman, Darin A. Padua and Jason P. Mihalik

squat speed slowed. A secondary purpose of this study was to determine if these relationships changed when a single-leg squat was completed under a dual-task paradigm compared with a single-task paradigm. We hypothesized that CoP range and sway area would increase, and sway speed would decrease to a

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Michael F. Joseph, Kathryn Taft, Maria Moskwa and Craig R. Denegar

Study Design:

Systematic literature review.

Objective:

To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy.

Context:

Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy. An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of “tendinitis.” However, increasing mechanical load to the tendinopathic tissue, as well as reducing molecular cross-linking during the healing process via transverse massage, offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy.

Evidence Acquisition:

The authors surveyed research articles in all languages by searching PubMed, Scopus, Pedro, CINAHL, PsycINFO, and the Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage, Cyriax, soft tissue mobilization, soft tissue mobilisation, cross friction massage, and transverse friction massage. They included 4 randomized comparison trials, 3 at the extensor carpi radialis brevis (ECRB) and 1 supraspinatus outlet tendinopathy; 2 nonrandomized comparison trials, both receiving DFM at the ECRB; and 3 prospective noncomparison trials—supraspinatus, ECRB, and Achilles tendons. Articles meeting inclusion criteria were assessed based on PEDro and Centre for Evidence-Based Medicine rating scales.

Results:

Nine studies met the inclusion criteria.

Evidence Synthesis:

The heterogeneity of dependent measures did not allow for meta-analysis.

Conclusion:

The varied locations, study designs, etiopathogenesis, and outcome tools used to examine the efficacy of DFM make a unified conclusion tenuous. There is some evidence of benefit at the elbow in combination with a Mills manipulation, as well as for supraspinatus tendinopathy in the presence of outlet impingement and along with joint mobilization. The examination of DFM as a single modality of treatment in comparison with other methods and control has not been undertaken, so its isolated efficacy has not been established. Excellent anecdotal evidence remains along with a rationale for its use that fits the current understanding of tendinopathy.

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Dan Campbell