Changes in Hamstring Range of Motion After Neurodynamic Sciatic Sliders: A Critically Appraised Topic.

Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared with stretching on traditional measures of range of motion (ROM)? Summary of Key Findings: The authors of a well-designed study found that neurodynamic sliders were more effective than static stretching, while the authors of 2 less-well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared with traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM in patients with limited hamstring flexibility.

Examination of overhead and single-leg squat kinematics and lower extremity injury in female collegiate athletes.

BACKGROUND: Overhead squat (OHS) and single-leg squat (SLS) tests have been used as screening tools to identify injury risk in athletic populations. Yet, no study has examined the association between specific trunk and lower extremity (LE) kinematic measures acquired during OHS and SLS performance and LE injury incidence in female collegiate athletes. The purpose of this study was to examine the association between LE and trunk kinematics captured during OHS and SLS performance and LE injury in female collegiate athletes. METHODS: This was a prospective cohort study. One hundred eight Division I female collegiate athletes underwent OHS and SLS testing before the start of their competitive season. A Microsoft Kinect sensor using Athletic Movement Assessment software (PhysiMax®) was used to capture kinematic variables: hip flexion, knee flexion, knee frontal plane projection angle (FPPA), and trunk flexion. Participants were tracked during one competitive season for incidence of LE injury. Logistic regression models were used to examine the association between OHS and SLS measures and injury. RESULTS: Twenty-three (21.3%) participants suffered a LE injury. No significant associations were found between any OHS (odds ratio [OR] range: 0.91-1.08) or SLS (OR range: 0.81-1.22) kinematic measure and incidence of LE injury. CONCLUSIONS: Sagittal plane LE and trunk kinematics and knee FPPA during OHS and SLS performance were not associated with LE injury in this cohort of athletes. Our findings do not support the use of these select kinematic measures captured during OHS and SLS testing as stand-alone injury risk assessments in female collegiate athletes.

Confirmatory Factor Analysis of the Athlete Sleep Behavior Questionnaire.

CONTEXT: Sleep has long been understood as an essential component for overall well-being, substantially affecting physical health, cognitive functioning, mental health, and quality of life. Currently, the Athlete Sleep Behavior Questionnaire (ASBQ) is the only known instrument designed to measure sleep behaviors in the athletic population. However, the psychometric properties of the scale in a collegiate student-athlete and dance population have not been established. OBJECTIVE: To assess model fit of the ASBQ in a sample of collegiate traditional student-athletes and dancers. DESIGN: Observational study. SETTING: Twelve colleges and universities. PATIENTS OR OTHER PARTICIPANTS: A total of 556 (104 men, 452 women; age = 19.84 ± 1.62 years) traditional student-athletes and dancers competing at the collegiate level. MAIN OUTCOME MEASURE(S): A confirmatory factor analysis (CFA) was computed to assess the factor structure of the ASBQ. We performed principal component analysis extraction and covariance modeling analyses to identify an alternate model. Multigroup invariance testing was conducted on the alternate model to identify if group differences existed for sex, sport type, injury status, and level of competition. RESULTS: The CFA on the ASBQ indicated that the model did not meet recommended model fit indices. An alternate 3-factor, 9-item model with improved fit was identified; however, the scale structure was not consistently supported during multigroup invariance testing procedures. CONCLUSIONS: The original 3-factor, 18-item ASBQ was not supported for use with collegiate athletes in our study. The alternate ASBQ was substantially improved, although more research should be completed to ensure that the 9-item instrument accurately captures all dimensions of sleep behavior relevant for collegiate athletes.

Sex differences in lower extremity kinematics during overhead and single leg squat tests.

The Overhead Squat (OHS) and Single-Leg Squat (SLS) are two clinical tests used by practitioners to identify high-risk biomechanical movement patterns. Several published studies have reported sex differences in SLS performance; however, few have investigated variations during the OHS and none has measured kinematics with a marker-less motion capture system. Therefore, this study aimed to compare biomechanical movement patterns between male and female collegiate athletes during OHS and SLS testing. Seventy-five females and 58 male athletes completed OHS and SLS . A Microsoft Kinect sensor using Athletic Movement Assessment software (PhysiMax®) was used to measure kinematics. For the OHS, males displayed greater peak knee frontal plane projection angles (FPPA) (M:26°±10°, F:20°±8°; P < 0.05), peak hip flexion (M:-94°±14°, F:-87°±15°; P < 0.05), and peak trunk flexion angles (M:11°±11°, F:6°±9°; P < 0.05). For the SLS (dominant-limb), males displayed greater peak trunk flexion (M:32°±6°, F:27°±7°; P < 0.05). For the non-dominant limb, females displayed greater peak knee FPPA (F:-12°±9°, M:-8°±9°; P < 0.05) whereas males displayed greater peak trunk flexion angles (M:32°±5°, F:27°±7°; P < 0.05). These findings suggest the need for practitioners to develop sex-specific corrective exercise programmes in effort to improve lower extremity kinematics in athletes.

Peak Lower Extremity Landing Kinematics in Dancers and Nondancers.

CONTEXT: Anterior cruciate ligament (ACL) injuries often occur during jump landings and can have detrimental short-term and long-term functional effects on quality of life. Despite frequently performing jump landings, dancers have lower incidence rates of ACL injury than other jump-landing athletes. Planned versus unplanned activities and footwear may explain differing ACL-injury rates among dancers and nondancers. Still, few researchers have compared landing biomechanics between dancers and nondancers. OBJECTIVE: To compare the landing biomechanics of dancers and nondancers during single-legged (SL) drop-vertical jumps. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 39 healthy participants, 12 female dancers (age = 20.9 ± 1.8 years, height = 166.4 ± 6.7 cm, mass = 63.2 ± 16.4 kg), 14 female nondancers (age = 20.2 ± 0.9 years, height = 168.9 ± 5.0 cm, mass = 61.6 ± 7.7 kg), and 13 male nondancers (age = 22.2 ± 2.7 years, height = 180.6 ± 9.7 cm, mass = 80.8 ± 13.2 kg). INTERVENTION(S): Participants performed SL-drop-vertical jumps from a 30-cm-high box in a randomized order in 2 activity (planned, unplanned) and 2 footwear (shod, barefoot) conditions while a 3-dimensional system recorded landing biomechanics. MAIN OUTCOME MEASURE(S): Overall peak sagittal-plane and frontal-plane ankle-, knee-, and hip-joint kinematics (joint angles) were compared across groups using separate multivariate analyses of variance followed by main-effects testing and pairwise-adjusted Bonferroni comparisons as appropriate ( P < .05). RESULTS: No 3-way interactions existed for sagittal-plane or frontal-plane ankle (Wilks λ = 0.85, P = .11 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 1.00, P = .93 and Wilks λ = 0.94, P = .36, respectively), or hip (Wilks λ = 0.99, P = .88 and Wilks λ = 0.97, P = .62, respectively) kinematics. We observed no group × footwear interactions for sagittal-plane or frontal-plane ankle (Wilks λ = 0.94, P = .43 and Wilks λ = 0.96, P = .55, respectively), knee (Wilks λ = 0.97, P = .60 and Wilks λ = 0.97, P = .66, respectively), or hip (Wilks λ = 0.99, P = .91 and Wilks λ = 1.00, P = .93, respectively) kinematics, and no group × activity interactions were noted for ankle frontal-plane (Wilks λ = 0.92, P = .29) and sagittal- and frontal-plane knee (Wilks λ = 0.99, P = .81 and Wilks λ = 0.98, P = .77, respectively) and hip (Wilks λ = 0.88, P = .13 and Wilks λ = 0.85, P = .08, respectively) kinematics. A group × activity interaction (Wilks λ = 0.76, P = .02) was present for ankle sagittal-plane kinematics. Main-effects testing revealed different ankle frontal-plane angles across groups ( F2,28 = 3.78, P = .04), with male nondancers having greater ankle inversion than female nondancers ( P = .05). CONCLUSIONS: Irrespective of activity type or footwear, female nondancers landed with similar hip and knee kinematics but greater peak ankle eversion and less peak ankle dorsiflexion (ie, positions associated with greater ACL injury risk). Ankle kinematics may differ between groups due to different landing strategies and training used by dancers. Dancers' training should be examined to determine if it results in a reduced occurrence of biomechanics related to ACL injury during SL landing.

A NOVEL APPROACH TO TREATING PLANTAR FASCIITIS - EFFECTS OF PRIMAL REFLEX RELEASE TECHNIQUE: A CASE SERIES.

BACKGROUND/PURPOSE: Plantar fasciitis (PF), a common condition affecting physically active individuals, is typically treated with orthotics, two to four months of stretching programs, and/or surgery. Primal Reflex Release Technique™ (PRRT) is thought to reduce over-arousal of the nervous system through down-regulation of the primal reflexes. The technique has been suggested as a novel treatment method for patients suffering from PF. The purpose of this case series was to examine the effects of PRRT on patients with PF. DESCRIPTION OF CASES: The PRRT technique was applied in eight consecutive cases of PF in physically active subjects. The Numeric Pain Rating Scale, the Disability in the Physically Active (DPA) Scale, and the Patient Specific Functional Scale (PSFS) were administered to identify patient-reported pain and dysfunction. OUTCOMES: Primal Reflex Release Technique (PRRT) was an effective treatment for subjects with either acute or chronic PF. The use of the PRRT treatment resulted in an average reduction in plantar fascia pain across all subjects that was both statistically significant and clinically following a single treatment. Statistically and clinically significant improvements on averaged measures of function, such as the DPA Scale and PSFS, were also found over the course of treatment. DISCUSSION: In this case series, the use of PRRT produced positive changes in terms of improvements in reported pain and dysfunction and a shorter time to resolution, when compared to traditional treatment methods for PF reported in the literature. Subjects who undergo PRRT treatment for both acute and chronic PF may experience reduction in pain and improvement of function that exceeds what is experienced in traditional conservative therapy programs found in the available literature. Clinicians should consider the regional interdependence model in order to identify underlying related factors when evaluating and treating PF. The autonomic nervous system may play a role in the perception of pain and should be addressed during treatment. LEVEL OF EVIDENCE: Level 4 - case series.

A NOVEL APPROACH FOR THE REVERSAL OF CHRONIC APPARENT HAMSTRING TIGHTNESS: A CASE REPORT.

BACKGROUND AND PURPOSE: Movement dysfunction in the trunk and lower extremity (e.g., apparent hamstring tightness) may produce pain, as well as decrease range of motion, function, and performance in athletes. Novel treatments not frequently studied in the literature, such as Total Motion Release® (TMR®) and instrument-assisted soft -tissue mobilization (IASTM), have anecdotal claims of immediate, gross gains of mobility that far exceed conventionally reported results. The purpose of this case report was to examine the efficacy of TMR® in treating an apparent tissue tightness/extensibility dysfunction and to determine if IASTM would improve outcomes if TMR® techniques failed to produce maintained improvement. CASE DESCRIPTION: A 27-year old former competitive speed walker presented with a chronic history of bilateral pain and posterior leg tightness. The patient met the criteria for diagnosis of a bilateral tissue extensibility dysfunction in the posterior lower extremity and was treated with TMR® and IASTM (Técnica Gavilán®; Tracy, California, United States). OUTCOMES: After the first week of treatment, the patient increased her sit and reach by 5cm and her active straight leg raise (ASLR) by an average of 31.5 ° bilaterally. Following the second week of treatment, the patient experienced an additional increase in sit and reach and ASLR. At discharge, the patient displayed negative 90/90 Active Knee Extension, Tripod, and Slump tests bilaterally, normalized ASLR and a resolution of her complaints. Follow-up examinations completed at one month and three months post-discharge indicated maintenance of the outcomes without any additional interventions. DISCUSSION: The subject in this case report demonstrated the potential use of TMR® in classifying apparent hamstring tightness and provided evidence to support the use of TMR® and IASTM in addressing mobility deficits associated with hamstring inflexibility/tightness. Based on these findings, clinicians should consider the use of TMR® to improve classification and treatment of patients with a chief complaint of hamstring "tightness." LEVEL OF EVIDENCE: Level 4; single case report.