Use of Cine Loops and Structural Landmarks in Ultrasound Image Processing Improves Reliability and Reduces Error in the Assessment of Foot and Leg Muscles.

OBJECTIVES: Foot and leg muscle strength and size are crucial to proper function. It is important to assess these characteristics reliably. Our primary objective was to compare the measurement of still images to cine loops. The secondary purpose was to determine interoperator and intraoperator reliability between operators of different experience levels using video clips and internal and external landmarks. METHODS: Twelve healthy volunteers participated in our study. Internal (navicular tuberosity) and external (lateral leg length at 30% and 50% from the knee joint line) landmarks were used. Two operators each captured and later measured still and cine loop images of selected foot and leg muscles. RESULTS: The 12 participants included 8 male and 4 female volunteers (mean age ± SD, 23.5 ± 1.9 years). Good to excellent intraoperator and interoperator reliability was seen (intraclass correlation coefficient range of 0.946-0.998). The use of cine loops improved the intraclass correlation coefficients for both intraoperator and interoperator reliability (0.5%-4% increases). The use of cine loops decreased the intraoperator standard error of the measurement and limits of agreement of the novice operator (decreases of 45%-73% and 24%-51%, respectively), and these became comparable to those of experienced operators using still images. The interoperator standard errors of the measurement dropped by 42% to 53%, whereas the limits of agreement dropped by 27% to 40%. No substantial changes were noted in the tibialis anterior across reliability metrics. CONCLUSIONS: Improved protocols that take advantage of using internal bony landmarks and cine loops during both the image-gathering and measurement processes improve the reliability of research examining muscle size changes in the lower leg or foot associated with muscle changes due to exercise, injury, disuse, or disease.

Does achilles tendon cross sectional area differ after downhill, level and uphill running in trained runners?

In this study we examined how hill running affects the Achilles tendon, a common location for injuries in runners. Twenty females ran for 10 min on each of three randomly ordered grades (-6%, 0 and +6%) at speeds selected to match the metabolic rates. Achilles tendon (AT) cross-sectional area (CSA) was imaged using Doppler ultrasound and peak vertical forces were analyzed using an instrumented treadmill. A metabolic cart and gas analyzer ensured a similar metabolic cost across grades. Data were analyzed using a forward selection regression. Results showed similar decreases in AT CSA from pre- to post-run for all three conditions of ~5 to 7% (p = 0.0001). Active peak vertical forces were different across grades (p = 0.0001) with the largest occurring during downhill running and smallest during uphill running. Since changes in AT CSA were not different between grades, each form of running appears equal and acceptable in regards to how the Achilles tendon reacts. That is, the results suggest that the Achilles tendon is affected by downhill, level, and uphill running and a decrease in CSA appears to be a normal response. Key PointsDownhill (- 6%), level and uphill (+ 6%) running at different speeds each caused a statistically significant decrease in the Achilles tendon cross-sectional area in healthy, trained runners.The magnitude of change in Achilles tendon cross-sectional area did not differ between grades when metabolic cost of running was matched.Downhill running resulted in the largest peak vertical force, while uphill running resulted in the smallest.

Comparison of the Traditional, Swing, and Chicken Wing Volleyball Blocking Techniques in NCAA Division I Female Athletes.

In volleyball, blocking is highly correlated with team success. The identification of specific techniques that produce a more successful block would be helpful knowledge for coaches and players. This study compared the traditional, swing, and "chicken wing" blocking techniques in combination with the running step footwork pattern in order to determine which technique enabled athletes to perform a more effective block. High-speed videography (7 cameras, Vicon Motion Analysis System) was used to capture the blocking movements of thirteen female NCAA Division I athletes (age = 19.4 ± 1.19 years, height = 1.82 ± 0.08 m, mass = 70.63 ± 7.96 kg, and years of participation at the collegiate level = 2.23 ± 1.17 years). Each player was familiar with each blocking technique. Reflective markers were placed on the players and in randomized order the players performed 3 blocking trials of each technique. The following dependent variables were assessed: The time it took the athletes to get off the ground and get their hands above (vertically) the net was calculated. The distance the hand reached over the net or hand penetration (displacement between the net and finger in the anterior and vertical planes) was also measured. Lastly, jump height was calculated. Repeated measures ANOVA and post-hoc comparisons were done (α = 0.05). There was no significant difference in the main effect for time to get off the ground (p > 0.05). There was a significant difference in the time to get the hands above the net (p < 0.05). The swing block was best for jump height (p <.001) and hand penetration (p < 0.05). These results can help coaches and players decide which blocking technique will benefit them most as a blocking team and as individual blockers. Key pointsThe swing blocking technique resulted in greater jump heights and increased hand penetration, relative to the traditional and chicken wing blocking techniques.The chicken wing blocking technique resulted in greater jump heights and increased hand penetration, relative to the traditional blocking technique.THE TRADITIONAL BLOCKING TECHNIQUE DOES NOT APPEAR TO PROVIDE ANY COMPETITIVE ADVANTAGE RELATED TO THE VARIABLES OBSERVED DURING THIS STUDY: (1) duration spent getting off of the ground and placing hands over the net, (2) jump height, and (3) hand penetration magnitude.

Preseason Screen Cannot Predict Injury over Three Years of College Football.

PURPOSE: This study aimed to investigate if the Functional Movement Screen (FMS) total score, individual component test scores, or number of asymmetries can predict noncontact injury risk over three consecutive seasons of National Collegiate Athletic Association Division I football. METHODS: Because football teams comprise individuals with vastly different physical characteristics and playing responsibilities, we divided the subjects into three homogeneous groups based on position (big, combo, and skill). Each FMS score was assessed with regard to the total team score and by individual position groups. For our injury analysis, we also controlled for exposure. Two hundred and eight National Collegiate Athletic Association Division I athletes participated over three consecutive seasons, yielding a total of 343 observations. RESULTS: There was no significant relationship between total FMS score and likelihood of injury when analyzed by the total team or by position group. These findings were the same for all groups, for both the total number of injuries and injuries weighted by injury exposure. The only significant findings occurred when we considered individual test item scores to injury by position group. We only found a significant relationship in the expected direction with push-up stability in the combo group. CONCLUSIONS: FMS was not a good predictor of noncontact injury.

Comparison of Varying Heel to Toe Differences and Cushion to Barefoot Running in Novice Minimalist Runners.

There are many different types of footwear available for runners in today's market. Many of these shoes claim to help runners run more efficiently by altering an individual's stride mechanics. Minimalist footwear claims to aid runners run more on their forefeet whereas more traditional footwear provides more cushioning specifically for a heel first landing. The purpose of this paper was to determine if runners, who were accustomed to running in traditional footwear would alter their running mechanics while running acutely in various types of minimalist footwear. Twelve subjects, accustomed to running in traditional 12 mm heel/toe differential footwear, ran in five footwear conditions on a treadmill at a controlled pace for two minutes after warming up in each condition for 5 minutes. While running in 12 mm heel/toe differential footwear compared to barefoot, subjects ran with a significantly longer ground time, a lower stride rate and greater vertical oscillation. There were not any differences in variables when running in the shod conditions despite the varying heel/toe differentials. Running barefoot proved to be different than running in traditional 12 mm drop cushioned footwear.

Understanding the complete pathophysiology of chronic mild to moderate neck pain: Implications for the inclusion of a comprehensive sensorimotor evaluation.

BACKGROUND: Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE: The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS: A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS: A statistically significant increase in NRE in flexion (2.75∘± 1.52∘ vs. 4.53∘± 1.74∘ and in extension (3.78∘± 1.95∘ vs 5.77∘± 2.73∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.

Reliability of doming and toe flexion testing to quantify foot muscle strength.

BACKGROUND: Quantifying the strength of the intrinsic foot muscles has been a challenge for clinicians and researchers. The reliable measurement of this strength is important in order to assess weakness, which may contribute to a variety of functional issues in the foot and lower leg, including plantar fasciitis and hallux valgus. This study reports 3 novel methods for measuring foot strength - doming (previously unmeasured), hallux flexion, and flexion of the lesser toes. METHODS: Twenty-one healthy volunteers performed the strength tests during two testing sessions which occurred one to five days apart. Each participant performed each series of strength tests (doming, hallux flexion, and lesser toe flexion) four times during the first testing session (twice with each of two raters) and two times during the second testing session (once with each rater). Intra-class correlation coefficients were calculated to test for reliability for the following comparisons: between raters during the same testing session on the same day (inter-rater, intra-day, intra-session), between raters on different days (inter-rater, inter-day, inter-session), between days for the same rater (intra-rater, inter-day, inter-session), and between sessions on the same day by the same rater (intra-rater, intra-day, inter-session). RESULTS: ICCs showed good to excellent reliability for all tests between days, raters, and sessions. Average doming strength was 99.96 ± 47.04 N. Average hallux flexion strength was 65.66 ± 24.5 N. Average lateral toe flexion was 50.96 ± 22.54 N. CONCLUSIONS: These simple tests using relatively low cost equipment can be used for research or clinical purposes. If repeated testing will be conducted on the same participant, it is suggested that the same researcher or clinician perform the testing each time for optimal reliability.

The time course of dexamethasone delivery using iontophoresis through human skin, measured via microdialysis.

STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To determine the time course of dexamethasone sodium phosphate (Dex-P) during iontophoresis to underlying tissues using microdialysis. BACKGROUND: In human participants, real-time information of Dex-P transdermal delivery during iontophoresis is unknown. METHODS: Sixty-four healthy male participants (mean ± SD age, 24.2 ± 3.3 years; height, 181.8 ± 26.1 cm; mass, 82.4 ± 11.8 kg; subcutaneous fat thickness, 0.61 ± 0.19 cm) were randomly assigned into 1 of 6 groups: (1) 1-mA current, 1-mm probe depth; (2) 1-mA current, 4-mm probe depth; (3) 2-mA current, 1-mm probe depth; (4) 2-mA current, 4-mm probe depth; (5) in vivo retrodialysis; and (6) skin perfusion flowmetry. Microdialysis probes were used to assess the combined recovery (Dex-total) of Dex-P, dexamethasone, and its metabolite. RESULTS: There was no difference in Dex-total between current intensities (P = .99), but a greater amount of Dex-total was recovered superficially at 1 mm compared to the 4-mm depth (P<.0001). Peak concentration mean ± SD values for the 1- and 2-mA currents at 1 mm were 10.8 ± 8.1 and 7.7 ± 5.5 µg/mL, and at 4 mm were 2.0 ± 0.8 and 1.3 ± 0.9 µg/mL, respectively. Peak skin perfusion was 741.4% ± 408.7% and 711.6% ± 260.8% at baseline for 1- and 2-mA intensities, respectively. Skin perfusion returned to baseline levels earlier during 1-mA intensity at a 110 mA · min dose within the treatment, compared to 2 mA at 60 minutes posttreatment. CONCLUSION: Transdermal delivery of Dex-P during iontophoresis was successfully measured in vivo through human skin. Measurable concentrations of Dex-total were found regardless of current intensity. Although current-induced vasodilation occurred, it did not significantly affect the tissue accumulation of Dex-total.

A randomized single-blind controlled trial comparing two monochromatic near-infrared light devices: implications for tissue heating and safety.

OBJECTIVE: Use of near-infrared light (NIR) is becoming more commonplace in the treatment of different pathologies; however, its safety in terms of heat generation and penetration has not been documented. The purpose of this investigation was to determine and compare skin surface and underlying tissue temperature response during and for 15 mins after a 30-min NIR application to the posterior lower leg using two different NIR devices (Anodyne and HealthLight) and one sham treatment. With this information, recommendations regarding potential adverse skin reactions, including burns, can be made. In addition, these results can serve as a reference for further studies. DESIGN: This single-blind randomized controlled study used a repeated-measures design. Fifteen healthy college-age individuals randomly received 30-min treatments with two different near-infrared devices and one sham device to their lower leg. A thermistor underneath the diode and a thermocouple with temperature sensors at three depths measured the temperature at skin surface and in deep tissues, respectively, every minute during the treatment and for 15 mins posttreatment. RESULTS: After 30 mins of treatment, there was a significant temperature increase between the NIR devices underneath the diodes and all tissue depths and the control. The skin temperature underneath the treatment diodes increased about 9.5°C from baseline to 40°C. There was no difference between the tissue temperature changes in response to the irradiation with the two NIR heating devices. A limitation of the study is that the entire sample was drawn from a healthy college population. CONCLUSIONS: The surface and underlying tissue temperature heating produced by the two NIR devices is within limits considered safe for healthy subjects.

Restless legs syndrome and near-infrared light: An alternative treatment option.

There are few treatment options in managing restless legs syndrome (RLS); the most frequently used are dopaminergic drugs and movement. New treatment options are highly sought after. This study evaluated the effectiveness of monochromatic near-infrared light treatment in decreasing symptoms associated with RLS. The design used was 2×6 repeated-measures design with two groups (treatment and control) and six repeated measures (baseline, weeks 1-4, and posttreatment). Data collection took place in the university modalities laboratory. Thirty-four volunteers with symptoms of RLS were randomly assigned to a treatment or control group. Over a 4-week period subjects underwent twelve 30-min treatments to their lower legs with near-infrared light. The International RLS rating scale (IRLS) was used to assess and track patient symptoms. There was a steady decrease in symptoms associated with RLS over the 4 weeks in the treatment group. After 4 weeks of treatment the treatment group had a significantly greater improvement in restless legs syndrome symptoms than the control group (p<0.001); improvement was still significant after 4 weeks posttreatment compared to baseline (p<0.001). Treatment with near-infrared light does decrease symptoms associated with RLS as demonstrated in lower IRLS scores. This new noninvasive method of treating RLS might become a valuable new management option. More research is needed to determine the mechanism(s) behind infrared light treatment and RLS.

Whole-body vibration strengthening compared to traditional strengthening during physical therapy in individuals with total knee arthroplasty.

This study investigated the use of whole-body vibration (WBV) as an alternative strengthening regimen in the rehabilitation of individuals with total knee arthroplasty (TKA) compared with traditional progressive resistance exercise (TPRE). Individuals post TKA (WBV n = 8; TPRE n = 8) received physical therapy with WBV or with TPRE for 4 weeks. Primary dependent variables were knee extensor strength, quadriceps muscle activation, mobility, pain, and range of motion (ROM). There was a significant increase in knee extensor strength and improvements in mobility, as measured by maximal volitional isometric contraction and the Timed Up and Go Test (TUG), respectively, for both groups (p < 0.01). The WBV knee extensor strength improved 84.3% while TPRE increased 77.3%. TUG scores improved 31% in the WBV group and 32% for the TPRE group. There were no significant differences between groups for strength or muscle activation (Hotelling's T(2) = 0.42, p = 0.80) or for mobility (F = 0.54; p = 0.66). No adverse side effects were reported in either group. In individuals with TKA, both WBV and TPRE showed improved strength and function. Influence of WBV on muscle activation remains unclear, as muscle activation levels were near normal for both groups.

Neurophysiological reflex mechanisms' lack of contribution to the success of PNF stretches.

BACKGROUND AND PURPOSE: Proprioceptive neuromuscular facilitation (PNF) stretches are widely used in athletics and rehabilitation. Although it has been shown that they produce better range-of-motion (ROM) increases than the slow or static stretch, the mechanisms responsible remain an enigma. This study was conducted to determine whether the previously proposed neurophysiological mechanisms of reciprocal inhibition and autogenic inhibition are responsible for the success of PNF stretches. In addition, the authors assessed the existence of the phenomenon of successive induction because it is used to strengthen reciprocal inhibition. METHODS: Eighteen subjects 17-44 y performed the PNF stretches contract-relax (CR) and contract-relax, agonist contract (CRAC). EMG data were collected from the medial hamstring muscles via surface and indwelling wire electrodes and analyzed for reciprocal inhibition and successive induction, as well as autogenic inhibition (surface electrodes only). RESULTS: Reciprocal inhibition was not evident. The results indicated an elevated rather than an inhibited EMG during the antagonist contraction, possibly representing cocontraction. The authors did confirm the presence of successive induction. Autogenic inhibition was also not evident, and the expected inhibition and therefore lower EMG values after muscle contraction were not observed; instead, they were higher than baseline. CONCLUSION: Previous neurophysiological explanations for mechanisms of PNF stretching appear to be inadequate. This study corroborates previous findings that a muscle's tone increases during its antagonist's contraction. Other explanations should be considered regarding the mechanism for the effectiveness of the CRAC and CR PNF techniques in a nonneurologically impaired population.

Acute stretch perception alteration contributes to the success of the PNF "contract-relax" stretch.

CONTEXT: Some researchers have suggested that an alteration of stretch perception could be responsible for the success of the contract-relax (CR) stretch, a stretch technique derived from proprioceptive neuromuscular facilitation (PNF). OBJECTIVE: This study was conducted to determine if the alteration of the stretch perception is a possible explanation for the range of motion (ROM) gains of the CR stretch. PARTICIPANTS: Eighteen subjects performed two stretches in randomized order: the slow stretch and the CR stretch. MAIN OUTCOME MEASURE: The stretch intensity was controlled. The stretch force was measured and compared between the slow stretch and CR stretch. RESULTS: There was a significant difference between the stretch force that could be applied in the PNF stretch (126.0 N) and the slow stretch (108.4 N); P = 0.00086. The average stretch tolerance progressively increased with successive trials from 120.6 N in the first trial to 132.4 N in the fourth trial. CONCLUSION: The alteration of stretch perception plays a role in the success of the CR form of PNF stretching. At least four repetitions of the CR stretch are recommended to get the greatest ROM gain.

Intramuscular Temperature Rises With Topical Analgesics Used as Coupling Agents During Therapeutic Ultrasound.

OBJECTIVE: To compare the effectiveness of Nature's Chemist as an ultrasound coupling agent with the effectiveness of another topical analgesic (Biofreeze), Aquasonic 100, and a sham treatment in producing intramuscular (IM) temperature increase during a typical therapeutic ultrasound treatment. DESIGN AND SETTING: Subjects were randomly assigned to 1 of 4 treatment groups (n = 10 in each group). Groups 1 through 3 received continuous ultrasound at 1.0 W/cm(2) for 10 minutes at a frequency of 3 MHz over the posterior calf. Group 4 received a sham treatment. In group 1, we used Aquasonic 100 alone; in group 2, we used a 1:1 (wt/wt) mixture of Biofreeze and Aquasonic 100; in group 3, we used a 1:1 mixture of Nature's Chemist and Aquasonic 100; and in group 4, we used a 1:1 mixture of Aquasonic 100 and Nature's Chemist. In all groups, IM temperature was recorded during the treatment and for 15 minutes posttreatment. We used a modified visual analogue scale to measure each subject's perception of heat at the treatment area during and after treatment. SUBJECTS: Forty college students (age, 22.5 +/- 2.0 years; height, 175.5 +/- 8.0 cm; weight, 71.6 +/- 13.1 kg; calf skinfold thickness, 17.8 +/- 7.2 mm) volunteered to become subjects. MEASUREMENTS: The IM temperature was recorded at 15-second intervals for 25 minutes at 1 cm below the subcutaneous fat with a thermocouple. Differences were analyzed within and among groups at the beginning of the treatment (T(0)), the end of the treatment (T(10)), and 15 minutes posttreatment (T(25)). RESULTS: The IM temperature increases in groups 1 through 3 were significantly different from those in group 4 (sham), but they were not significantly different from each other. Temperatures increased in group 1 (Aquasonic 100) by 7.47 degrees +/- 1.8 degrees C, in group 2 (Biofreeze and Aquasonic 100) by 6.52 degrees +/- 1.6 degrees C, and in group 3 (Nature's Chemist and Aquasonic 100) by 6.99 degrees +/- 1.1 degrees C. Temperatures decreased in group 4 (sham) by 0.56 degrees +/- 0.3 degrees C. There were no significant differences among groups 1 through 3 in the perception of heat at T(5) and T(10). CONCLUSIONS: Our results indicate that, at a frequency of 3 MHz and an intensity of 1 W/cm(2), Nature's Chemist and Biofreeze mixed in 1:1 ratios with Aquasonic 100 were effective coupling agents. Perceptions of heat by the patient may not indicate actual temperature increases within the muscle.

The effects of a topical analgesic and placebo in treatment of chronic knee pain.

Chronic knee pain is a prevalent health problem of old and middle age. The authors' objective was to determine whether a topical analgesic would reduce knee pain and improve the function of a group of 40- to 65-year-old people with chronic knee pain. The experimental design was a double-blind, randomized, placebo-controlled clinical trial. The dependent variables were knee pain, active range of motion, and isometric strength. Forty-six men and women volunteered, of whom 3 dropped out, leaving 23 in the treatment group and 20 in the placebo group. Knee pain was assessed with a visual analogue scale and the knee-pain scale for frequency and severity. Testing took place before treatment and after 21 and 35 days of treatment. The results indicated that although both groups experienced improved pain scores, there were no differences between groups over the treatment period for any of the dependent variables.

Cordyceps Sinensis (CordyMax Cs-4) supplementation does not improve endurance exercise performance.

It is purported that supplementation with Cordyceps Sinensis (CordyMax Cs-4) will improve oxidative capacity and endurance performance. The intent of this investigation was to examine the effects of CordyMax Cs-4 supplementation on VO<(2peak,) ventilatory threshold, and endurance performance in endurance-trained cyclists. Twenty-two male cyclists participated in 5 weeks of supplementation with CordyMax Cs-4 tablets (3 g/d). Training intensity was maintained by weekly documentation and reporting throughout the 5-week period. Subjects completed a VO(2peak) test and work-based time trial prior to and following the supplementation period. VO(2peak) was similar within and between placebo (PLA) and treatment (CS) groups prior to (59.9 +/- 5.9 vs. 59.1 +/- 5.4 ml/kg/min, respectively) and following (60.1 +/- 5.5 vs. 57.1 +/- 5.8 ml/kg/min, respectively) the supplementation period. Ventilatory threshold (VT) was measured at 72 +/- 10% of VO(2peak) in P and T prior to supplementation and did not change in either group following the supplementation. PLA completed the time trial in 61.4+/- 2.4 min compared to 62.1+/- 4.0 min in T. Time trial measurements did not differ between groups, nor did they change in response to supplementation. It is concluded that 5 weeks of CordyMax Cs-4 supplementation has no effect on aerobic capacity or endurance exercise performance in endurance-trained male cyclists.