Self-Movement Screening using the Symmio Application is Reliable and Valid for Identifying Musculoskeletal Risk Factors.

Background: Musculoskeletal health problems are one of the greatest healthcare expenses in the United States but patient-driven screening procedures to detect risk factors do not exist. Hypothesis/Purpose: The purpose was to establish the inter-rater reliability of the Symmio Self-Screen application in untrained individuals and to investigate its accuracy to detect MSK risk factors such as pain with movement, movement dysfunction, and decreased dynamic balance. Study Design: Cross-Sectional. Methods: Eighty (42 male, 38 female) healthy individuals mean age 26.5 ± 9.4 participated in the study. The inter-rater reliability of Symmio application was established by comparing self-screen scores from untrained subjects with the results simultaneously determined by a trained healthcare provider. Each subject was evaluated for pain with movement, movement dysfunction, and deficits in dynamic balance by two trained evaluators who were blinded to the Symmio results. The validity of Symmio was determined by comparing self-screen performance dichotomized as pass or fail with the reference standard of pain with movement, failure on the Functional Movement Screen™, and asymmetry on the Y Balance Test-Lower Quarter™ using three separate 2x2 contingency tables. Results: The mean Cohen's kappa coefficient was 0.68 (95% CI, 0.47-0.87) and the absolute agreement was 89% between self-assessment of subjects and the observation of a trained healthcare provider. There were significant associations for the presence of pain with movement (p=0.003), movement dysfunction (p=0.001), and dynamic balance deficits (p=0.003) relative to poor Symmio performance. The accuracy of Symmio to identify pain with movement, movement dysfunction, and dynamic balance deficits were 0.74 (95% CI, 0.63-0.83), 0.73 (95% CI, 0.62-0.82), and 0.69 (95% CI, 0.57-0.79), respectively. Conclusions: The Symmio Self-Screen application is a reliable and feasible screening tool that can be used to identify MSK risk factors. Level of Evidence: Level 2.

Reliability and Differences Between Sexes in Landing Mechanics when Performing the Lateral Bound Test.

Background and Purpose: Anterior cruciate ligament injuries are prevalent among the athletic population, imposing a heavy economic burden, and the risk of re-injury. Most current biomechanical screening tasks are performed in the sagittal plane, and there is a need for more screening tools that assess sports specific movements in the frontal plane. The purpose of this study was to determine the reliability of and examine differences between sexes in the performance of the Lateral Bound Test (LBT). Materials/Methods: Each subject performed three trials of a LBT which included jumping laterally from one leg over a hurdle and landing on the opposite leg. Two cameras were placed six feet from the landing marker. Maximum dynamic knee valgus using the frontal plane projection angle and knee flexion angle at initial contact and maximal knee flexion were measured upon landing leg using 2D video analysis software. Additionally, video of 10 individuals' trials were analyzed twice with one week between the analyses to obtain intra-rater reliability while 12 participants were retested one week later to determine test-retest reliability. Results: Thirty healthy subjects, 16 males, 14 females participated. Intra-rater reliability was determined to be excellent for all variables (ICC>0.96). In contrast, the test-retest reliability had greater disparity. Test-retest reliability ranged from poor (ICC = 0.47) to excellent (ICC > 0.90). Significant differences existed between the sexes, including males being significantly taller, weighing more, and demonstrating greater bilateral dynamic knee valgus (p < 0.05). No significant differences existed between sexes for knee flexion angles. Conclusion: The new LBT had excellent intra-rater reliability for assessing dynamic knee valgus and initial and maximum knee flexion angle when performing a functional movement in the frontal plane. Furthermore, males landed with more dynamic knee valgus than females which is contradictory to what has been observed with functional screening tools performed in the sagittal plane. Level of Evidence: 3b (reliability study).

Does the Direction of Kinesiology Tape Application Influence Muscle Activation in Asymptomatic Individuals?

BACKGROUND: Despite the popularity of tape among athletes and rehabilitation practitioners, there is controversy regarding the specific effects of kinesiology tape. Based on conflicting results and limitations of the literature, a well-designed study was desired to examine kinesiology tape application direction on muscle activation. HYPOTHESIS/PURPOSE: The purpose of this pilot study was to determine if the direction of kinesiology tape application influences quadriceps activation. This study compared taping techniques with outcome measures selected to assess quadriceps muscle activation. The outcome measures included EMG, isokinetic strength, and functional hop and jump performance. STUDY DESIGN: Double-blind Crossover study. METHODS: A total of fifteen asymptomatic participants (10 females and 5 males) completed the study. Mean age was 23.3 years. KinesioⓇ Tex GoldTM was applied to the dominant lower extremity of each participant using a Y-strip method. Two taping conditions (proximal to distal, distal to proximal) were applied to the quadriceps. Participants and testers were blinded to tape condition. Pretest and posttest measures included electromyographic output during isokinetic testing of quadriceps muscle torque at 60°s-1 and 120°s-1, single leg triple hop for distance, and vertical jump. RESULTS: Two-way, repeated measures analysis of variance resulted in no significant differences in baseline to taped condition for quadriceps electromyographic output, quadriceps isokinetic knee extension muscle torque at 60°s-1 and 120°s-1, single leg triple-hop distance or vertical jump height. CONCLUSION: The results of this pilot study do not support the hypothesis that kinesiology tape application direction influences muscle performance as measured in this study. LEVELS OF EVIDENCE: Level 1 - Controlled Clinical Trial. CLINICAL RELEVANCE: Kinesiology tape is commonly used as an intervention for a wide range of musculoskeletal conditions and for promoting performance including sporting activities. Kinesiology tape is popular among athletes and health care providers yet the specific effects of tape are not well understood.

Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial.

BACKGROUND: People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs). OBJECTIVE: To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs. DESIGN: Prospectively registered randomized controlled trial with a blinded assessor. SETTING: Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics. PATIENTS: Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP. INTERVENTION: Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment-based treatment, for more than 6 weekly 1-hour sessions plus home exercises. MEASUREMENTS: Pre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. RESULTS: Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task. LIMITATIONS: Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure. CONCLUSIONS: Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment-based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).