Effects of functional movement screen training in high-school baseball players: A randomized controlled clinical trial.

BACKGROUND: In recent years, the functional movement screen (FMS) and FMS training have attracted attention as a means of preventing injury, but no studies have examined the effect of such training in high-school baseball players. The aim of this study was to clarify the effect of FMS training on FMS score, physical function and baseball performance in high-school baseball players. METHODS: Subjects in this randomized controlled clinical trial were high-school male baseball players assigned to either an FMS training group (intervention group) or a control group. The intervention group performed FMS training 4 times per week for 12 weeks. FMS ability, physical function, and baseball performance were measured prior to the intervention, 8, 12, and 24 weeks after the intervention in the subjects' school environment. RESULTS: A total of 71 baseball players aged 15 to 17 years were recruited and assigned to either an intervention group (n = 37) or control group (n = 34). There was no significant difference in the characteristics of participants between the 2 groups. Most FMS scores improved to 12 weeks after continued training. In the intervention group compared with the control group, deep squat, hurdle step, inline lunge, active straight leg raise, trunk stability push-up and rotary stability FMS score, total FMS score and eyes closed single leg stance time significantly increased after 8 weeks of training. While hurdle step, inline lunge, active straight leg raise, trunk stability push-up, total FMS score, and eyes closed single leg stance time significantly increased, pitching ball speed significantly decreased at the end of the 12 week training period. Eyes closed single leg stance time and feeling of fatigue significantly improved 12 weeks after training. The number of subjects who scored less than 14 for the total FMS score in the intervention group compared with control group were significantly less after 8 and 12 weeks of FMS training. CONCLUSION: FMS training for 8 weeks contributes to improving FMS scores for high-school baseball players, but FMS scores go down if FMS training is not continued. TRIAL REGISTRATION: University Hospital Medical Information Network Center, Tokyo, Japan: UMIN000027553. Registered on May 30, 2017.

The C0-C2 axial rotation test - Reliability and correlation with the flexion rotation test in people with cervicogenic headache and migraine.

OBJECTIVES: The C0-C2 axial rotation test is a measure of upper cervical range of motion (UCROM), reported to be reliable in a headache free population. The objective was to determine the intra- and inter-rater reliability of the C0-C2 axial rotation test in people with a diagnosis of cervicogenic headache (CGH) or episodic migraine. METHODS: Two therapists independently evaluated UCROM during the C0-C2 axial rotation test and flexion-rotation test (FRT) with an iPhone in 70 subjects (mean age 37.7 SD 11.6 years) with a diagnosis of CGH (35 subjects) or episodic migraine (35 subjects) on two occasions. Measurement procedures were standardized; and the order of testing randomized. RESULTS: Reliability of the C0-C2 axial rotation test was moderate to high (ICC > 0.70). The standard error of measurement and minimum detectable change for this test were at most 2°. In subjects with CGH mean UCROM to the most restricted side was 9.3° (1.9) and 8.8° (2.1) for rater 1 and 2 respectively. While in patients with episodic migraine mean UCROM to the restricted side was 13.7° (1.6) and 13.6° (2.0) for rater 1 and 2 respectively. DISCUSSION: The C0-C2 axial rotation test has at least moderate levels of reliability and correlates well with mobility determined by the FRT.

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial.

OBJECTIVES: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis. DESIGN: A randomised controlled trial. SETTING: A general hospital. SUBJECTS: Forty adults with knee osteoarthritis (grade 1-3 Kellgren-Lawrence scale). INTERVENTIONS: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. MAIN MEASURES: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. RESULTS: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. CONCLUSION: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

Mulligan Knee Taping Using Both Elastic and Rigid Tape Reduces Pain and Alters Lower Limb Biomechanics in Female Patients With Patellofemoral Pain.

BACKGROUND: Evidence supports the use of Mulligan knee taping in managing patellofemoral pain (PFP). However, no studies have compared the efficacy of rigid and elastic tape using this technique. HYPOTHESIS: Mulligan knee taping applied with both rigid and elastic tape will produce similar reductions in knee pain, hip internal rotation, and knee flexion moments compared with no tape. Elastic tape will also be more comfortable than rigid tape. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 19 female patients (mean age, 26.5 ± 4.5 years) with PFP performed a self-selected pain provocative task, single-leg squat (SLSq) task, and running task while wearing Mulligan knee taping applied with rigid tape, elastic tape at 100% tension, and no tape. Pain and taping comfort were recorded using 11-point numeric rating scales. An 18-camera motion capture system and in-ground force plates recorded 3-dimensional lower limb kinematics and kinetics for the SLSq and running tasks. Statistical analysis involved a series of repeated-measures analyses of variance. The Wilcoxon signed rank test was used for analyzing taping comfort. RESULTS: Compared with no tape, both rigid and elastic tape significantly reduced pain during the pain provocative task (mean difference [MD], -0.97 [95% CI, -1.57 to -0.38] and -1.42 [95% CI, -2.20 to -0.64], respectively), SLSq (MD, -1.26 [95% CI, -2.23 to -0.30] and -1.13 [95% CI, -2.09 to -0.17], respectively), and running tasks (MD, -1.24 [95% CI, -2.11 to -0.37] and -1.16 [95% CI, -1.86 to -0.46], respectively). Elastic tape was significantly more comfortable than rigid tape generally (P = .005) and during activity (P = .022). Compared with no tape, both rigid and elastic tape produced increased knee internal rotation at initial contact during the running task (MD, 5.5° [95% CI, 3.6° to 7.4°] and 5.9° [95% CI, 3.9° to 7.9°], respectively) and at the commencement of knee flexion during the SLSq task (MD, 5.8° [95% CI, 4.5° to 7.0°] and 5.8° [95% CI, 4.1° to 7.4°], respectively), greater peak knee internal rotation during the running (MD, 1.8° [95% CI, 0.4° to 3.3°] and 2.2° [95% CI, 0.9° to 3.6°], respectively) and SLSq tasks (MD, 3.2° [95% CI, 2.1° to 4.3°] and 3.8° [95% CI, 2.3° to 5.2°], respectively), and decreased knee internal rotation range of motion during the running (MD, -3.6° [95% CI, -6.1° to -1.1°] and -3.7° [95% CI, -6.2° to -1.2°], respectively) and SLSq tasks (MD, -2.5° [95% CI, -3.9° to -1.2°] and -2.0° [95% CI, -3.2° to -0.9°], respectively). CONCLUSION: Mulligan knee taping with both rigid and elastic tape reduced pain across all 3 tasks and altered tibiofemoral rotation during the SLSq and running tasks. CLINICAL RELEVANCE: Both taping methods reduced pain and altered lower limb biomechanics. Elastic tape may be chosen clinically for comfort reasons.

The clinical utility of pain classification in non-specific arm pain.

Mechanisms-based pain classification has received considerable attention recently for its potential use in clinical decision making. A number of algorithms for pain classification have been proposed. Non-specific arm pain (NSAP) is a poorly defined condition, which could benefit from classification according to pain mechanisms to improve treatment selection. This study used three published classification algorithms (hereafter called NeuPSIG, Smart, Schafer) to investigate the frequency of different pain classifications in NSAP and the clinical utility of these systems in assessing NSAP. Forty people with NSAP underwent a clinical examination and quantitative sensory testing. Findings were used to classify participants according to three classification algorithms. Frequency of pain classification including number unclassified was analysed using descriptive statistics. Inter-rater agreement was analysed using kappa coefficients. NSAP was primarily classified as 'unlikely neuropathic pain' using NeuPSIG criteria, 'peripheral neuropathic pain' using the Smart classification and 'peripheral nerve sensitisation' using the Schafer algorithm. Two of the three algorithms allowed classification of all but one participant; up to 45% of participants (n = 18) were categorised as mixed by the Smart classification. Inter-rater agreement was good for the Schafer algorithm (к = 0.78) and moderate for the Smart classification (к = 0.40). A kappa value was unattainable for the NeuPSIG algorithm but agreement was high. Pain classification was achievable with high inter-rater agreement for two of the three algorithms assessed. The Smart classification may be useful but requires further direction regarding the use of clinical criteria included. The impact of adding a pain classification to clinical assessment on patient outcomes needs to be evaluated.

Low back related leg pain: an investigation of construct validity of a new classification system.

BACKGROUND: Leg pain is associated with back pain in 25-65% of all cases and classified as somatic referred pain or radicular pain. However, distinction between the two may be difficult as different pathomechanisms may cause similar patterns of pain. Therefore a pathomechanism based classification system was proposed, with four distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization (NS) comprising major features of neuropathic pain with sensory sensitization; Denervation (D) arising from significant axonal compromise; Peripheral Nerve Sensitization (PNS) with marked nerve trunk mechanosensitivity; and Musculoskeletal (M) with pain referred from musculoskeletal structures. OBJECTIVE: To investigate construct validity of the classification system. METHODS: Construct validity was investigated by determining the relationship of nerve functioning with subgroups of patients and asymptomatic controls. Thus somatosensory profiles of subgroups of patients with low back related leg pain (LBRLP) and healthy controls were determined by a comprehensive quantitative sensory test (QST) protocol. It was hypothesized that subgroups of patients and healthy controls would show differences in QST profiles relating to underlying pathomechanisms. RESULTS: 77 subjects with LBRLP were recruited and classified in one of the four groups. Additionally, 18 age and gender matched asymptomatic controls were measured. QST revealed signs of pain hypersensitivity in group NS and sensory deficits in group D whereas Groups PNS and M showed no significant differences when compared to the asymptomatic group. CONCLUSIONS: These findings support construct validity for two of the categories of the new classification system, however further research is warranted to achieve construct validation of the classification system as a whole.

Reliability of thermal quantitative sensory testing: a systematic review.

The use of quantitative sensory testing (QST) has become more widespread, with increasing focus on describing somatosensory profiles and pain mechanisms. However, the reliability of thermal QST has yet to be established. We systematically searched the literature using key medical databases. Independent reviewers evaluated reliability data using the Quality Appraisal for Reliability Studies checklist. Of the 21 studies we included in this review, we deemed 5 to have high methodological quality. Narrative analysis revealed that estimates of reliability varied considerably, but overall, the reliability of cold and warm detection thresholds ranged from poor to excellent, while heat and cold pain thresholds ranged from fair to excellent. The methodological quality of research investigating the reliability of thermal QST warrants improvement, particularly in terms of appropriate blinding. The results from this review showed considerable variability in the reliability of each thermal QST parameter.

Agreement and correlation between the self-report leeds assessment of neuropathic symptoms and signs and Douleur Neuropathique 4 Questions neuropathic pain screening tools in subjects with low back-related leg pain.

OBJECTIVE: The self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Douleur Neuropathique 4 Questions (DN4) neuropathic pain screening tools have been shown to be reliable, valid, and able to differentiate neuropathic pain from inflammatory or mixed pain syndromes. However, no studies have compared these tools to determine whether their outcomes are similar. This study evaluated agreement and correlation between the S-LANSS and DN4 in the identification of neuropathic pain in subjects with low back-related leg pain. METHODS: This observational study compared S-LANSS and DN4 scores in 45 patients with low back-related leg pain. The S-LANSS and DN4 cutoff scores of 12 and 4, respectively, were used to classify subjects as positive or negative for the presence of neuropathic pain for each screening tool. The κ statistic was used to determine whether there was agreement in classification of neuropathic pain between the 2 screening tools. Pearson correlation coefficient was used to determine correlation between scores of the 2 screening tools. RESULTS: Neuropathic pain was identified in 15 subjects (33%) using the S-LANSS and in 19 subjects (42%) using the DN4. Agreement on neuropathic pain classification was fair, with a κ value of 0.34. There was moderate to good correlation (r = 0.62; P < .001) between scores obtained from the 2 tools. CONCLUSIONS: The finding of fair agreement suggests that despite the moderate to good correlation between scores, the cutoff points for the classification of neuropathic pain of the 2 tools may not be congruent.

Reliability of thermal quantitative sensory testing of the hand in a cohort of young, healthy adults.

INTRODUCTION: The reliability of thermal quantitative sensory testing (QST) has yet to be fully established. In this study we investigated intra- and interrater reliability of thermal QST in a blinded manner. METHODS: Two investigators recorded thermal detection and pain thresholds on the hand of 22 volunteers, twice on two occasions. Results were analyzed using descriptive statistics, intraclass correlation coefficients (ICCs), and coefficients of variation (CVs). RESULTS: Mean intraindividual differences were small for all measures except cold pain thresholds. ICC values for intra- and interrater reliability were: cold detection, 0.27-0.55; warm detection, 0.33-0.69; and heat pain, 0.39-0.86. Cold pain yielded high ICC values (0.87-0.94), but also high CV (84.9-90.2%). CONCLUSIONS: In young, healthy adults, thermal detection and heat pain thresholds of the hand demonstrated good reliability for group comparisons and individual analyses. Cold pain threshold measures may be suitable for group comparisons, but a large variance in the data limits individual analyses.

The relationship between cervicogenic headache and impairment determined by the flexion-rotation test.

OBJECTIVE: This study evaluates the association between probable cervicogenic headache (CGH) and associated headache symptoms and cervical spine impairment identified by the flexion-rotation test (FRT). METHODS: This was an observational study. Ninety-two subjects were evaluated, 72 with probable CGH and 20 who were asymptomatic. Headache symptoms were evaluated by questionnaire. A single blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion (ROM). Fifteen subjects reported headache during testing and were subsequently retested when pain-free. A paired t test was used to determine whether FRT mobility to the most restricted side differed when the subject was experiencing headache. Univariate linear regression analysis and multiple regression analysis were used to examine the relationship between subject and headache characteristics, and range of motion during the FRT. Logistic regression analysis was used to examine relationships between subject and headache characteristics and whether the FRT was positive or negative. RESULTS: Mean ROM was significantly reduced (P < .01) by 6° in the presence of headache, but this did not influence test interpretation. Regression analysis revealed that half the variance in FRT ROM was explained by an index of headache severity or component parts but not by other headache characteristics. CONCLUSIONS: These findings indicate a relationship between cervical movement impairment and the presence and severity of CGH.

Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test.

The aim of this study was to compare the findings of the cervical flexion-rotation test (FRT) between subjects with probable cervicogenic headache (CGH), migraine without aura (Migraine), and multiple headache forms (MHF). An additional aim was to identify the diagnostic accuracy of the FRT in CGH evaluation. Sixty subjects were evaluated: 20 with CGH, 20 with Migraine, and 20 with MHF. Subject and headache symptoms were evaluated by questionnaire. A single-blind examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. The average range of unilateral rotation to the most restricted side was 25°, 42° and 35° for groups CGH, Migraine and MHF, respectively. The difference between groups was significant (P < 0.001). Range of rotation was significantly reduced in the CGH group when compared to groups Migraine (P < 0.001) and MHF (P = 0.001), with an additional smaller significant difference between groups Migraine and MHF (P = 0.039). A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 85% of the time (P < 0.001), with a positive cut-off value of 30°. Multivariate regression analysis revealed that 44% of the variance in FRT range of motion was explained by the presence of two variables: neck movement or positions provoke headache, and neck symptoms precede headache, but not by other factors associated with migraine. These findings provide further evidence supporting the clinical utility of the FRT in CGH evaluation.

Interrater reliability of a new classification system for patients with neural low back-related leg pain.

The aim of this study was to investigate the reliability of a new classification system for low back-related leg pain arising from neural tissue dysfunction. Leg pain is a frequent accompaniment to back pain and is an indicator of the severity and prognosis of the disorder. For optimal patient care, treatment should be directed according to the identified pathophysiological mechanisms. The authors have proposed a sub-classification of neural low back-related leg pain into four categories, each requiring a different management strategy: Central Sensitization (CS), comprising major features of sensitization of the somatosensory system; Denervation (D), arising from significant axonal compromise without evidence of major central nervous system changes; Peripheral Nerve Sensitization (PNS), arising from nerve trunk inflammation without clinical evidence of significant denervation; and Musculoskeletal pain (M), referred from non-neural structures such as the disc or facet joints. The purpose of this study was to investigate the interrater reliability of this classification system. Forty consecutive patients with unilateral low back-related leg pain were independently assessed by five pairs of examiners using a physical examination protocol, screening for central sensitization of the somatosensory system, neurological deficit, and nerve tissue mechano-sensitization. Subjects were classified as follows: CS 30%, D 27.5%, PNS 10%, and M 32.5%. Interrater reliability was good with 80% agreement and a k of 0.72 (95% Confidence Interval (CI) .57-.86). The findings of the study demonstrate that patients with low back-related leg pain can be reliably classified to one of the four proposed groups.

Intertester reliability and diagnostic validity of the cervical flexion-rotation test.

OBJECTIVE: This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test (FRT) to discriminate subjects with headache because of C1/2 dysfunction. In addition, this study evaluates agreement between experienced and inexperienced examiners. METHODS: These were 2 single blind comparative measurement study designs. In study 1, 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where C1/2 was the primary dysfunctional level, and 10 subjects with CeH but without C1/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2,1), and Bland-Altman plot were used to analyze FRT range of rotation between the examiners. Sensitivity, specificity, and examiner agreement for test interpretation were analyzed using cross tabulation and kappa. RESULTS: In study 1, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% (P < .001) and kappa = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and kappa values were all within clinically acceptable levels. CONCLUSIONS: The FRT can be used accurately and reliably by inexperienced examiners and may be a useful aid in CeH evaluation.