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BACKGROUND: Improving single leg squat (SLS) movement symmetry may benefit rehabilitation protocols. The Total Motion Release® (TMR®) protocol has been theorized to evaluate and improve patient-perceived movement asymmetries. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate whether perceived asymmetries identified by a TMR® scoring protocol were related to biomechanical asymmetries and whether improving perceived asymmetries influenced movement mechanics. It was hypothesized that participants with perceived asymmetries would also present with biomechanical asymmetries. A secondary hypothesis was that participants would reduce their perceived asymmetries after performing the TMR® protocol and subsequently have greater biomechanical symmetry. STUDY DESIGN: Descriptive Cohort (Laboratory Study). METHODS: Twenty participants (10 female, 10 male) with self-identified bilateral differences of 10 points or greater on the TMR® scoring scale were recruited for the study. The non-preferred side was defined as the side that scored higher. 3Dimensional motion capture was used to bilaterally assess baseline SLS depth as well as hip, knee, and ankle kinematics and kinetics. For the TMR® protocol, sets of 10 SLSs were performed on the preferred leg until their perceived asymmetries were resolved (i.e., both sides scored equally), or four sets had been completed. Kinematics and kinetics were collected immediately after the intervention and after a 10-minute rest period. RESULTS: Participants had biomechanical asymmetries at baseline for knee flexion, ankle flexion, and knee moments. Following the intervention, participants had reduced TMR® scores on the non-preferred leg, and this coincided with increased knee joint moments on that side. Although perceived asymmetries were resolved after the intervention, kinematic and kinetic asymmetries at the knee and ankle were still present. CONCLUSIONS: A TMR® intervention could benefit rehabilitation protocols by reducing factors of dysfunction and increasing the ability of patients to load the non-preferred knee. Further investigations are necessary to elucidate the importance of asymmetrical movement patterns. LEVEL OF EVIDENCE: 3b.
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Objective: The purpose of this study was to examine whether the forces used by trained clinicians during a simulated instrument-assisted soft tissue mobilisation (IASTM) treatment varied across five different instruments during one-handed and two-handed IASTM grips. Methods: Nine athletic trainers who previously completed IASTM training and used the technique in professional practice were included in the study. A skin simulant was attached to a force plate and used to evaluate force production during a simulated IASTM treatment scenario. Peak (Fpeak) and mean (Fmean) forces were recorded for both one-handed and two-handed grips for each participant across the five instruments. Data were analysed using separate 2 (grip type) × 5 (IASTM instrument) repeated measures analysis of variance for both Fpeak and Fmean. Results: Data for Fpeak demonstrated a significant main effect for grip type (F(1, 8)=46.39, p<0.001, η p 2 =0.34), instrument (F(4, 32)=4.61, p=0.005, η p 2 =0.06) and interaction (F(2, 16)=10.23, p=0.001, η p 2 =0.07). For Fmean, there was also a statistically significant main effect for grip type (F(1, 8)=60.47, p<0.001, η p 2 =0.32), instrument (F(4, 32)=4.03, p=0.009, η p 2 =0.06) and interaction (F(2, 19)=7.92, p=0.002, η p 2 =0.06). Conclusions: Clinicians produced greater IASTM forces when applying a two-handed grip than a one-handed grip. Instrument weight may matter less than instrument shape, size and bevelling for influencing force production as instrument length appears to influence force production when using one-handed or two-handed grips. Although the effects of IASTM force variation on patient outcomes remains unknown, these findings may be considered by clinicians when making instrument and grip choices.
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BACKGROUND: Lower limb asymmetries may be associated with increased injury risk in an active female population. However, an appropriate method for determining these asymmetries has not been established. HYPOTHESIS/PURPOSE: The purpose of the present study was to examine the single leg drop landing (SLD) kinematic waveforms of female recreational athletes for the pelvis, hip, and knee using statistical parametric mapping (SPM). It was hypothesized that individual bilateral differences would be masked by the group analysis. STUDY DESIGN: Descriptive Laboratory Study. METHODS: The current study examined the sagittal and frontal plane pelvis, hip, and knee kinematics of nine physically active females during a SLD. To better elucidate whether asymmetries were present between right and left limbs throughout the landing phase, data were analyzed with SPM. The time-series data were comprised from initial contact to the bottom of the landing. A single subject design was also included to account for potential interindividual variability. RESULTS: At the group level there were no statistical differences between the right and left limbs of participants for all variables. The single subject design yielded at least two significant asymmetries for all participants. Six out of the nine participants had bilateral differences for all six kinematic time-series. CONCLUSIONS: The lack of significant differences at the group level may have been masked by movement variability amongst participants. For example, when considering participants with significant differences for hip flexion, four participants had greater values on the left limb and three on the right. A similar observation was made for knee flexion where three participants had significantly greater kinematic values on the left versus four on the right. Until a method is developed to adequately dichotomize lower extremities during the SLD task, a single subject design strategy be used with group analysis when making bilateral comparisons. LEVEL OF EVIDENCE: 3.
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Background: Instrument-assisted soft tissue mobilization (IASTM) is a commonly utilized intervention for musculoskeletal pain and dysfunction. However, little is known regarding the reliability of forces applied by clinicians of different experience levels during an IASTM intervention. Purpose: The purpose of this pilot study was to assess intra-clinician reliability of IASTM force (i.e., mean normal force) during a simulated, one-handed stroke IASTM intervention across different levels of IASTM clinical experience. Design: Descriptive laboratory study. Methods: The researchers conducted a repeated measures trial in a laboratory setting with a convenience sample of ten participants who had previously completed professional IASTM training. Participants performed 15 one-handed sweeping strokes with an IASTM instrument on a skin simulant attached to a force plate for a standardized hypothetical treatment scenario. The participants performed the treatment on two separate days, 24-48 hours apart. The researchers examined the intra-rater reliability for average (mean) normal forces using Bland-Altman (BA) plots and Coefficient of Variation (CV) values. Results: The BA plot results indicated all participants (professional athletic training students = 4, athletic trainers = 6; males = 5, females = 5; age = 32.60 ± 8.71 y; IASTM experience = 3.78 ± 4.10 y), except participant D (1.9N, 190g), were consistently reliable within 1N (100g) or less of force for mean differences and within the maximum limits of agreement around 3.7N (370g). Most participants' CV scores ranged between 8 to 20% supporting reliable force application within each treatment session. Conclusion: The data indicated that IASTM trained clinicians could produce consistent forces within and across treatment sessions irrespective of clinical experience. Level of Evidence: 3.