The Effects of Light Pressure Instrument-Assisted Soft Tissue Mobilization at Different Rates on Grip Strength and Muscle Stiffness in Healthy Individuals.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial treatment utilized by health care professionals. Currently, there is a lack of research on the effects of a light pressure IASTM treatment on the forearm region. The purpose of this study was to explore the effects of a light pressure IASTM technique at different application rates on grip strength and muscle stiffness. This study was considered exploratory with the goal of establishing methodology for future controlled studies. DESIGN: Observational pretest and posttest clinical study. METHODS: Twenty-six healthy adults underwent one light pressure IASTM treatment to their dominant forearm muscles. Participants were allocated to 2 groups of 13 based upon treatment rate: 60 beats per minute and 120 beats per minute. Participants were tested pretreatment and posttreatment for grip strength and tissue stiffness via diagnostic ultrasound. One-way analyses of covariance were used to assess group differences posttreatment for grip strength and tissue stiffness. RESULTS: Statistically significant posttreatment changes for grip strength and tissue stiffness were not found. Despite the nonstatistical significance, there were small decreases in grip strength and tissue stiffness. Faster (120 beats/min) IASTM application may have produced clinically meaningful decreases in grip strength along with a small decrease in tissue stiffness. CONCLUSIONS: This report helps to establish methodology for future controlled studies on this topic. Sports medicine professionals should consider these results as exploratory and interpret them with caution. Future research is needed to confirm these findings and begin to postulate possible neurophysiological mechanisms.

Clinician Reliability of One-Handed Instrument-Assisted Soft Tissue Mobilization Forces During a Simulated Treatment.

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology. Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors' purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The authors' findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes.

Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment.

CONTEXT: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. OBJECTIVE: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. DESIGN: Experimental. SETTING: University research laboratory. PARTICIPANTS: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). INTERVENTION: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. MAIN OUTCOME MEASURES: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. RESULTS: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. CONCLUSIONS: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

Test-Retest Reliability of the Total Motion Release® Scale.

CONTEXT: Total Motion Release® (TMR®) is a novel treatment paradigm used to restore asymmetries in the body (eg, pain, tightness, limited range of motion). Six primary movements, known as the Fab 6, are performed by the patient and scored using a 0 to 100 scale. Clinicians currently utilize the TMR® scale to modify treatment, assess patient progress, and measure treatment effectiveness; however, the reliability of the TMR® scale has not been determined. It is imperative to assess scale reliability and establish minimal detectable change (MDC) values to guide clinical practice. OBJECTIVE: To assess the reliability of the TMR® scale and establish MDC values for each motion in healthy individuals in a group setting. DESIGN: Retrospective analysis of group TMR® assessments. SETTING: University classroom. PARTICIPANTS: A convenience sample of 61 students (23 males and 38 females; 25.48 [5.73] y), with (n = 31) and without (n = 30) previous exposure to TMR®. INTERVENTION: The TMR® Fab 6 movements were tested at 2 time points, 2 hours apart. A clinician with previous training in TMR® led participant groups through both sessions while participants recorded individual motion scores using the 0 to 100 TMR® scale. Test-retest reliability was calculated using an intraclass correlation coefficient (2,1) for inexperienced, experienced, and combined student groups. Standard error of measurement and MDC values were also assessed for each intraclass correlation coefficient. OUTCOME MEASURE: Self-reported scores on the TMR® scale. RESULTS: Test-retest reliability ranged from 0.57 to 0.95 across the Fab 6 movements, standard error of measurement values ranged from 4.85 to 11.77, and MDC values ranged from 13.45 to 32.62. CONCLUSION: The results indicate moderate to excellent reliability across the Fab 6 movements and a range of MDC values. Although this study is the first step in assessing the reliability of the TMR® scale for clinical practice, caution is warranted until further research is completed to establish reliability and MDC values of the TMR® scale in various settings to better guide patient care.

The Effect of Kinesio Tape on Factors for Neuromuscular Control of the Lower-Extremity: A Critically Appraised Topic.

Clinical Scenario: Joint instability is a common condition that often stems from inadequate muscle activation and results in precarious movement patterns. When clinicians attempt to mechanically treat the unstable joint rather than attending to the underlying cause of the instability, patient outcomes may suffer. The use of kinesiology tape (KT) on an unstable joint has been proposed to aid in improving lower-extremity neuromuscular control. Clinical Question: Does KT improve factors of neuromuscular control in an athletic population when compared with no-tape or nonelastic taping techniques? Summary of Key Findings: The current literature was searched, and 5 randomized controlled studies were selected comparing the effects of KT with no-tape or nonelastic taping techniques on lower-extremity neuromuscular control in an athletic population. Primary findings suggest KT is not more effective than no-tape or nonelastic tape conditions at improving lower-extremity neuromuscular control in a healthy population. Clinical Bottom Line: The current evidence suggests that KT is ineffective for improving neuromuscular control at the ankle compared with nonelastic tape or no-tape conditions. KT was also found to be ineffective at improving hip and knee kinematics in healthy runners and cyclists. However, preliminary research has demonstrated improved neuromuscular control in a population displaying excessive knee valgus during a drop jump landing, after the application of KT. Clinicians should be cautious of these conflicting results and apply the best available evidence to their evaluation of the patient's status. Strength of Recommendation: There is grade B evidence that the use of KT on an athletic population does not improve biomechanical measures of ankle stability. There is inconclusive, grade B evidence that KT improves neuromuscular control at the knee in symptomatic populations.

Effects of a Total Motion Release (TMR®) Protocol for the Single Leg Squat on Asymmetrical Movement Patterns.

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.

Effect of instrument type and one-handed versus two-handed grips on force application during simulated instrument-assisted soft tissue mobilisation.

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.

The Relationship Between Health and Movement Screens and Field-Based Physical Fitness Tests in Reserve Officer Training Corps Students.

The purpose of the present study was to evaluate the relationship between scores achieved in physical fitness tests and outcomes of health and movement screens (HMS) in ROTC students. Twenty-eight students (20 males: 21.8 yrs [± 3.4] & 8 females: 20.7 yrs [± 1.8]) enrolled in an ROTC branch (Army, Air Force, Navy, or Marines) completed a series of screens, including body composition analysis via Dual-Energy X-Ray Absorptiometry (DXA), balance and functional movement tasks via a lower-quarter Y-Balance test, and knee and hip joint concentric strength testing on an isokinetic dynamometer. Official ROTC PFT scores were collected from the respective military branch leadership. HMS outcomes were compared to PFT scores via Pearson Product-Moment Correlation and linear regression analyses. Across branches, total PFT scores were significantly correlated to visceral adipose tissue (r = -0.52, p = 0.01) and android:gynoid fat ratio (r = -0.43, p = 0.04). Visceral adipose tissue (R 2 = 0.27, p = 0.011) and android to gynoid ratio (R 2 = 0.18, p = 0.042) significantly predicted total PFT scores. No further significant correlations between HMS and overall PFT scores were observed. HMS scores revealed significant bilateral differences in lower extremity body composition (p < 0.001; d = 0.23) and strength (p = 0.002; d = 0.23). Across ROTC branches, HMS were poorly correlated with PFT performance yet indicated significant bilateral differences in lower extremity strength and body composition. The inclusion of HMS may ease the increasing injury rate among the military population by assisting in detection of movement shortcomings.

Examining movement asymmetries during three single leg tasks using interlimb and single subject approaches.

PURPOSE: s: To examine whether healthy individuals displayed asymmetric trunk and lower extremity kinematics in the frontal and sagittal planes using both interlimb and single subject models. METHODS: Trunk, pelvis, and lower extremity kinematic waveforms were analyzed bilaterally during the single leg squat (SLS), forward step down (FSD), and lateral step down (LSD). Participants identified task specific preferred and non-preferred legs based on perceived stability for interlimb analyses. Movement patterns were also analyzed with a single subject approach that included Fisher's exact tests to assess whether asymmetries were related to the task. RESULTS: Participants were found to have increased pelvic drop on the non-preferred leg during the LSD from 41 to 77% of the movement (p = 0.01). No other bilateral differences were found for interlimb analyses. Single subject analyses indicated that no task had a greater probability of finding or not finding asymmetries. Associations were found between the FSD and SLS for frontal plane hip (p < 0.01) and knee motion (p < 0.01). CONCLUSIONS: Interlimb analyses can be influenced by intraparticipant movement variability between preferred and non-preferred legs. Movement asymmetries during single leg weightbearing are likely task dependent and a battery of tests is necessary for assessing bilateral differences.

Lower Extremity Kinematic Waveform Analysis During a Single Leg Drop Task - Including a Single Subject Design.

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.

Exploring Force Production Reliability across Different Levels of Clinical Experience during a Simulated One-handed Instrument-Assisted Soft Tissue Mobilization Treatment: A Pilot Study.

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.

Descriptive Analysis of Forces Applied by Trained Clinicians During Two-Handed Instrument-Assisted Soft Tissue Mobilization.

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.