Suggestions and Considerations for Application of Movement Screens to Clinical Practice.

Pre-participation and return to activity functional assessments are commonly used in clinical practice to assess movement quality and identify athletes' limitations. While there are slight differences between each specific test battery, general guidelines suggest that the tests be completed without a warm-up. This has been suggested because dynamic stretching may improve range of motion and athletic performance. However, athletes typically warm up prior to participating in sport. Therefore, researchers should investigate the acute effects of dynamic stretching on functional tests and movement screens and evaluate other factors that may influence performance on these test batteries. Scientific evidence for standardized implementation of various movement screens is lacking, and future research should aim to identify gaps in the literature to allow clinicians to properly implement evidence-based practice functional assessments. The purpose of this commentary is to discuss various considerations for implementing movement screens and assessment tools into clinical practice. LEVEL OF EVIDENCE: 5.

Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain.

OBJECTIVES: To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures. DESIGN: Single-session crossover study. SETTING: Laboratory. PARTICIPANTS: Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year. INTERVENTIONS: Verbal cueing alone and verbal cueing with ultrasound biofeedback. MAIN OUTCOME MEASURES: Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials. RESULTS: Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally ( P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead ( P = 0.014) and trail ( P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 ( P < 0.001). CONCLUSIONS: Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.

Balance Error Scoring System Performance Differences in Figure Skaters Based on Discipline.

Background: Balance and postural stability are required of figure skaters throughout on-ice performance. Spinning, jumping, and landing each rely on this skill set to maintain control while skaters manage changing demands for each skating discipline. Hypothesis/Purpose: The aim of this study was to compare balance error scoring system (BESS) performance in figure skaters between disciplines and determine if age was related to BESS performance. Study Design: Cross-sectional study. Methods: Three hundred and fifty-eight figure skaters (age: 15.4±3.3 years, 213 females, 145 males) of multiple disciplines completed the BESS during the United States Figure Skating's Standardized Testing of Athleticism to Recognize Skaters (S.T.A.R.S.) combine. Errors during each condition of the BESS were recorded by trained evaluators. A 3x6 ANOVA was used to determine BESS differences based on skating discipline. Spearman's rho (ρ) correlation coefficients were calculated for relationships between BESS errors and age. Results: Ice dancers had more errors than singles and pairs for bipedal foam (p<0.001) but had fewer errors than single skaters for single leg foam (p=0.002). Tandem on a firm surface also showed an increase in errors for ice dancers and pairs skaters compared to singles (p<0.001). There were significant weak negative relationships noted between age and bipedal foam and single leg firm conditions (ρ=-0.14, -0.23, p<0.05). Conclusion: Figure skaters of different disciplines have varying levels of static postural stability. Assessing postural stability in figure skaters can provide insight to improve performance and may identify skaters at risk of injury. Level of Evidence: 3©The Author(s).

Optimizing normalization methods of the external oblique: A cross-sectional study.

BACKGROUND: Adequate normalization methodology to establish maximum voluntary isometric contraction (MVIC) is needed to compare %MVIC values for core exercise completed until discontinuation. Clinicians can use %MVIC classifications to guide their preventative and rehabilitative exercise interventions. OBJECTIVE: The aim of this study was to compare %MVIC of the external oblique (EO) between normalization techniques of side-lying lateral trunk flexion and Roman chair lateral trunk flexion. METHODS: Twenty-two participants completed two MVIC techniques followed by one repetition of the prone bridge plank (PBP), torso elevated side plank (TESP), foot elevated side plank (FESP), dead bug and bird dog. The average %MVIC during the first 5-seconds, last 5-seconds and overall duration of exercise were included for analysis. ANOVA was used to compare normalized %MVIC from each of the 5 exercises between MVIC techniques. Alpha set a priori p= 0.05. RESULTS: The side-lying table technique yielded no %MVIC values above 100%, while the Roman chair technique produced 7 values above 100%. The largest mean difference between techniques was during the last 5-seconds of the torso elevated side plank (57.87 ± 38.51%MVIC, p< 0.001). CONCLUSION: The side-lying table technique likely provides the optimal methodology of %MVIC determination.

Exploration of the Golf-Specific Low Back Pain Questionnaire.

OBJECTIVE: The primary purpose of this study was to determine internal consistency and concurrent validity of the Golf-specific Low Back Pain questionnaire (GLBP). DESIGN: Cross-sectional study. SETTING: Online questionnaire. PARTICIPANTS: Fifty-two adult golfers with a history of LBP. INTERVENTIONS: GLBP, Oswestry Disability Index (ODI). MAIN OUTCOME MEASURES: Cronbach alpha values for the GLBP and its 3 subscales. Pearson correlations between the ODI, GLBP, and the GLBP subscales. RESULTS: Cronbach alpha for the GLBP was 0.94. Cronbach alpha for the 3 GLBP subscales ranged from 0.85 to 0.91. All Pearson correlations were significant at P < 0.05. The correlation between the ODI and GLBP was -0.64, and correlations between the ODI and GLBP subscales ranged from -0.53 to -0.63. Mean GLBP score was 72.01% ± 16.15%, and mean ODI score was 12.00% ± 7.98%. CONCLUSIONS: The GLBP has excellent concurrent validity to quantify LBP in golfers. The GLBP total and each individual subscale have excellent internal consistency and a moderate inverse relationship with the ODI. The GLBP offers a more sport-specific patient-reported outcome measure for this population. The GLBP may more adequately quantify LBP-related disability, especially at lower levels of disability. Findings provide initial evidence that the GLBP may be a valid tool to quantify LBP symptoms and dysfunction in golfers. CLINICAL RELEVANCE: Clinicians should consider using sport-specific outcome measures when evaluating for LBP-related disability.

Relationship Between Muscle Activity and Force During Suspended Bridge Exercises.

CONTEXT: Isometric core stability exercises are commonly used to target muscles of the lumbopelvic-hip complex, including the rectus abdominis (RA) and erector spinae (ES). These exercises can be implemented in rehabilitation protocols to increase muscle strength and endurance. Difficulty can be progressed by modifying the base of support or adding an unstable element. Load cells can be affixed to suspension training devices to measure force exerted through the straps during exercise. The primary purpose of this study was to assess the relationship between activity of the RA and ES to force measured through a load cell fixed to suspension straps during bilateral and unilateral suspended bridge exercises. DESIGN: Forty asymptomatic, active individuals completed a single laboratory visit. METHODS: Participants completed 2 bilateral suspended bridges and 2 unilateral suspended bridges held to failure. Surface electromyography sensors were placed over the bilateral RA and ES to quantify muscle activity (% maximum voluntary isometric contraction). A load cell was affixed to the suspension straps to measure force exerted through the straps throughout the duration of the exercise. Pearson correlations were used to determine relationships between force and muscle activity of the RA and ES throughout exercise duration. RESULTS: Force was negatively related to RA muscle activity in bilateral suspended bridges (r = -.735 to -.842, P < .001) and unilateral suspended bridges (r = -.300 to -.707, P = .002 to <.001). Force had a positive relationship with ES muscle activity in bilateral suspended bridges (r = .689 to .791, P < .001) and unilateral suspended bridges (r = .418 to .448, P < .001). CONCLUSIONS: Suspended bridge exercises can be a valuable tool to target posterior abdominal musculature such as the ES to contribute to core stability and endurance. Load cells can be applied during suspension training to quantify the interaction between individuals and the exercise equipment.

Rectus abdominis muscle thickness change and activation increase during planks performed on different surfaces.

AIMS: The plank is a common exercise used to evaluate core function. Surface electromyography (sEMG) and ultrasound can be used simultaneously to measure muscle activity. We aimed to compare the %-thickness and %-activation during the plank performed on three surfaces and to determine agreement and relationship between rectus abdominis (RA) %-thickness of a rested tabletop position and %-activation normalized to quiet tabletop position during the plank on three surfaces. METHODS: In this cross-sectional study, ultrasound and sEMG measured RA muscle function during the first 5-s and last 5-s of a plank performed on a table, yoga mat, and fitness ball. A repeated measures ANOVA compared differences in %-thickness change and Friedman's tests compared differences in %-activation, alpha set a priori p ≤ 0.05. Bland-Altman plots measured agreement between instruments. Spearman's rho determined relationships between instruments. RESULTS: There was no difference between %-thickness change across surfaces during the first 5-s or last 5-s, or between %-activation during the last 5-s. The %-activation of the RA during the first 5-s performed on the fitness ball was higher than the table and yoga mat (p < 0.001). Ultrasound and sEMG had weak relationships across all surfaces (ρ = - 0.078 to 0.116). CONCLUSION: The first 5-s of the plank performed on the fitness ball requires a greater RA activation. Ultrasound could not detect changes in %-thickness of the RA during the plank which may be influenced by the type of contraction. Comparison between these measurement tools during isometric exercise should be used with caution.

Providing Visual Biofeedback Using Brightness Mode Ultrasound During a Golf Swing.

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional rehabilitation techniques in an athletic, physically active population. Brightness mode (B-mode) ultrasound can be applied using frame-by-frame analysis synchronized with video to understand muscle thickness changes during these dynamic tasks. Visual biofeedback with ultrasound has been established in static positions for the muscles of the lateral abdominal wall. However, by securing the transducer to the abdomen using an elastic belt and foam block, biofeedback can be applied during more specific tasks prevalent in lifetime sports, such as golf. To analyze muscle activity during a golf swing, muscle thickness changes can be compared. The thickness must increase throughout the task, indicating that the muscle is more active. This methodology allows clinicians to immediately replay ultrasound videos for patients as a visual tool to instruct proper activity of the muscles of interest. For example, ultrasound can be used to target the external and internal obliques, which play an important role in swinging a golf club or any other rotational sport or activity. This methodology aims to increase oblique muscle thickness during the golf swing. Additionally, the timing of muscle contraction can be targeted by instructing the patient to contract the abdominal muscles at specific time points, such as the beginning of the downswing, with the goal of improving muscle firing patterns during tasks.

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise.

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured between fascial borders at a given time point during an exercise. This selected time point produces a one-dimensional image resulting in real-time, live observation of anatomy. Ultrasound used during functional movement can be referred to as dynamic ultrasound; this is feasible and reliable with the use of a linear transducer, elastic belt, and foam block to secure consistent transducer placement. The lateral abdominal wall is commonly investigated using ultrasound due to the overlapping nature of the muscles. Surface electromyography (sEMG) can complement M-mode ultrasound imaging because it measures the electrical representation of muscle activation. There is minimal evidence using M-mode ultrasound and sEMG simultaneously during core exercise. Exercises that challenge the core musculature involve both isometric holds (e.g., side plank), as well as oscillatory extremity movements (e.g., dead bug). In this study, both instruments will be used simultaneously to measure core muscle function during exercise. Ultrasound measurements will be obtained using a linear transducer and ultrasound unit, and sEMG measurements will be acquired from a wireless sEMG system. To make comparisons between participants and exercises, normalization methods using static, exercise starting positions for both instruments will be used. An activation ratio will be used for ultrasound and calculated by dividing the contracted thickness (thickness during a time point of exercise) by the rested (starting position) thickness. Muscle thickness will be measured in centimeters from the superior inferior fascial border to inferior superior fascial border. These methods aim to offer an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises.

Transverse abdominis activity and ultrasound biofeedback in college golfers with and without low back pain.

OBJECTIVES: To compare transverse abdominis (TrA) muscle activity in college golfers with and without a history of low back pain (LBP) and examine the effects of ultrasound biofeedback and a functional golf-setup position on TrA activity. DESIGN: Crossover study. SETTING: Laboratory. PARTICIPANTS: Thirty-two (n = 32) collegiate golfers were stratified into either the LBP group (n = 16, 4.6 ± 4.5 LBP episodes) or non-LBP group (n = 16, 0.1 ± 0.3 LBP episodes) based on LBP episodes in the last 6-months. MAIN OUTCOME MEASURES: Ultrasound measures of TrA activity were performed during standard contractions and contractions with ultrasound biofeedback. Contraction-type order was randomized between two visits. Testing was performed in two positions, supine and golf-setup positions. RESULTS: We observed no significant differences in TrA activity between the LBP and non-LBP groups. Overall, TrA activity was greater during biofeedback contractions compared to standard contractions, and TrA activity was lower in the golf-setup position compared to the supine position. CONCLUSIONS: We observed no differences in TrA activity between college golfers with and without LBP. College golfers with and without LBP demonstrated a greater ability to contract their TrA with real-time ultrasound biofeedback and a lower ability to contract their TrA in the functional golf-setup position compared to the traditional supine position.