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Saito A, Okada K, Shibata K, Sato H, Namiki Y, Terui Y, Kikuchi T. Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players. Am J Sports Med 2023; 51:3409-3415. [PMID: 37815055 DOI: 10.1177/03635465231202028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Young baseball players with medial elbow injuries are known to have high forearm flexor-pronator muscle elasticity; however, the causal relationship between forearm muscle elasticity and the occurrence of medial elbow injuries remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to determine whether the forearm flexor-pronator muscle elasticity is a risk factor for medial elbow injury in young baseball players. It was hypothesized that high flexor carpi ulnaris (FCU) elasticity would be a risk factor for medial elbow injuries. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Young baseball players (aged 9-12 years) with no history of elbow injuries underwent examination during which the strain ratios (SRs) of the pronator teres, flexor digitorum superficialis, and FCU muscles were measured using ultrasound strain elastography as an index of elasticity. Additionally, the participants completed a questionnaire assessing age, height, weight, months of experience as a baseball player, position in baseball, number of training days per week, number of throws per day, and elbow pain during throwing; then the range of motion of the shoulder and hip internal/external rotation were measured. One year after the baseline measurements, the occurrence of new medial elbow injuries was evaluated. Multivariate logistic regression analysis was subsequently conducted to determine risk factors for medial elbow injuries. Cutoff points for significant SR values obtained from the multivariate logistic regression analysis were calculated using the receiver operating characteristic curve. RESULTS Of the 314 players, 76 (24.2%) were diagnosed with medial elbow injury. Multivariate logistic regression analysis showed that a 0.1 increase in the SR of the FCU muscle (odds ratio [OR], 1.211; 95% CI, 1.116-1.314) and number of throws per day (OR, 1.012; 95% CI, 1.001-1.022) were significantly associated with medial elbow injuries. Receiver operating characteristic curve analyses revealed that the optimal cutoff for the SR of the FCU muscle was 0.920 (area under the curve, 0.694; sensitivity, 75.0%; specificity, 56.7%). CONCLUSION Increased FCU elasticity is a risk factor for medial elbow injury. Evaluation of the FCU elasticity may be useful in identifying young baseball players at high risk of medial elbow injuries and may facilitate prevention of medial elbow injury. As shown by the results of multivariate logistic regression analysis, FCU elasticity itself may be useful in identifying young baseball players at high risk of elbow injuries. However, we believe that other factors, such as the number of pitches per day, need to be considered to improve its accuracy.
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Affiliation(s)
- Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | | | - Hiromichi Sato
- Department of Rehabilitation, Akita Kousei Medical Center, Akita, Japan
| | - Yusuke Namiki
- Department of Rehabilitation, Akita City Hospital, Akita, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Tsubasa Kikuchi
- Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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Sarac DC, Yalcinkaya G, Unver B. Validity and reliability of a smartphone goniometer application for measuring hip range of motions. Work 2022; 71:275-280. [PMID: 34924431 DOI: 10.3233/wor-213626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mobile applications which are designed to assess the range of motion (ROM) are widely used. OBJECTIVE The aim of this cross-sectional observational study was to determine the inter-observer and intra-observer reliability of a smartphone application "PT Goniometer" (PTG) and determine the correlation between PTG and universal goniometer (UG) regarding active ROMs of the hip in healthy participants. METHODS Thirty-four healthy young participants were included in the study. Two physiotherapists performed active hip flexion, abduction, internal rotation and external rotation ROM measurements of dominant legs of the participants by using PTG and UG. Intraclass correlation coefficients (ICC) were calculated to determine the intra-observer and inter-observer reliability. Level of correlations between PTG and UG were used to establish concurrent validity of PTG. RESULTS The PTG demonstrated excellent inter-observer and intra-observer reliability (ICC > 0.90) for all measured hip movements. The minimum detectable change (MDC95) was ranged from 3.29° to 5.1° for the intra-observer reliability, and from 2.55° to 3.21° for the inter-observer reliability. Additionally, the concurrent validity was found excellent (r = 0.91-0.93). CONCLUSION The results of the present study suggest that PTG is a valid and reliable mobile technology for measuring hip ROMs.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Gamze Yalcinkaya
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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The Intra- and Inter-Rater Reliability of a Hip Rotation Range-of-Motion Measurement Using a Smartphone Application in Academy Football (Soccer) Players. Sports (Basel) 2021; 9:sports9110148. [PMID: 34822348 PMCID: PMC8623895 DOI: 10.3390/sports9110148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
The clinical assessment of hip rotation range-of-motion (ROM) is important for managing hip and groin injuries in footballers. Previously published reliability studies on hip ROM have employed protocols that are difficult to replicate under everyday clinical conditions. This single trial, intra- and inter-rater reliability study included 41 male academy football (soccer) players, aged 14–15 years, from one European football academy. Passive hip internal rotation (IR) and external rotation (ER) ROM were measured in supine with hip and knee flexed to 90°. The ROM was determined using a smartphone application, with the smartphone attached to the lower leg. The tests were performed on two separate occasions, one week apart, by two different physiotherapists and on both sides (left and right hips). Reliability was evaluated using Intra-Class Correlation Coefficients (ICCs) and Minimal Detectable Change (MDC). Hip IR and ER ROM displayed moderate to good intra-rater agreement (ICCs 0.54–0.75), with MDCs ranging from 10.9° to 16.4°. Inter-rater reliability displayed poor to moderate reliability (ICCs 0.33–0.75), with MDCs ranging from 11.7° to 16.5°. A hip rotation ROM test using a smartphone application and a protocol closely reflecting everyday clinical conditions displayed moderate to good intra-rater reliability and poor to moderate inter-rater reliability. Due to the high MDCs, the practical applicability of this test procedure is limited and further refinement is necessary.
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Cejudo A, Ruiz-Pérez I, Hernández-Sánchez S, De Ste Croix M, Sainz de Baranda P, Ayala F. Comprehensive Lower Extremities Joints Range of Motion Profile in Futsal Players. Front Psychol 2021; 12:658996. [PMID: 34194363 PMCID: PMC8236511 DOI: 10.3389/fpsyg.2021.658996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
The purposes of this study were to describe the lower extremities joints range of motion (ROM) profile using a comprehensive approach in futsal players and to examine potential player position (goalkeepers vs. outfield players), competitive level (first [top] division vs. second division), number of playing years, sex (males vs. females), and bilateral (dominant limb vs. non-dominant limb) differences. A total of 72 male and 67 female elite futsal players from 11 clubs were measured of passive hip (flexion with knee flexed [HFKF] and extended [HFKE], extension [HE], abduction [HA], external [HER], and internal [HIR] rotation), knee (flexion [KF]) and ankle (dorsiflexion with knee flexed [ADFKF] and extended [ADFKE]) ROMs. Bayesian inferences exploring differences between player position, competitive level, sex and limb were made. A Bayesian correlation analysis was conducted to explore the influence of playing years on joints ROMs. The results showed no significant player position or competitive level related differences in any average ROM score. However, statistically significant sex-related differences were documented whereby female players reported higher hip and knee joints ROM average values than their male counterparts. Especially relevant were the proportions of males (72%) and players from teams engaged in the second division (61%) displaying limited HFKE ROMs. Likewise, around 35% of all players showed restricted ADFKF ROMs. In addition, approximately 21, 18, 22, and 25% of the futsal players were identified as having bilateral asymmetries (≥8°) for HA, HIR, HER, and KF ROMs, respectively. Finally, Bayesian correlation analysis did not report any significant association between years of playing futsal and ROM measures (all r values < 0.34). The implications that these restricted HFKE and ADFKF ROMs and bilateral asymmetries in hip (abduction, internal and external rotation) and knee (flexion) ROMs caused by the practice of futsal may have on physical performance and injury risk warrant future research.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Iñaki Ruiz-Pérez
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernandez University of Elche, Alicante, Spain
| | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Francisco Ayala
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain.,School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom.,Ramón y Cajal Postdoctoral Fellowship, Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
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Cranmer M, Walston Z. Heavy resistance training in the management of hip pain in older adults: A case series. Physiother Theory Pract 2021; 38:2241-2249. [PMID: 33896330 DOI: 10.1080/09593985.2021.1917022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background and Purpose: Resistance training has been shown to improve strength, endurance, and function in healthy older adults. The purpose of this case series was to describe the outcomes of a rehabilitation program consisting of heavy resistance training in older adults for management of hip pain. Case Description: Two male patients, aged 69 and 71, with chronic hip pain, participated in a six-week progressive resistance training rehabilitation program at loads equivalent to 76-81% of their one repetition maximum. Outcomes were assessed at evaluation, three, and six weeks. Outcomes included the Lower Extremity Functional Scale, hip and lumbar mobility, and the Five Times Sit to Stand test. Outcomes: By six weeks, each patient reported 0/10 pain and demonstrated clinically important improvements on the LEFS. Both patients' final scores on the Five Times Sit to Stand test fell below the 15 second value for being at risk for falls. Patient One increased his lifting capacity for the deadlift by 92%, and Patient Two by 56%. Both patients were able to deadlift >70% of their one repetition maximum by the conclusion of this report. Discussion: To our knowledge, this is the first report of the outcomes of utilizing heavy resistance training in elderly adults with hip pain in a rehabilitative setting. Both patients demonstrated clinically important improvements in pain, disability, global lower extremity strength, and function by the conclusion of six weeks duration. Further research is needed regarding the effectiveness of heavy resistance training for the treatment of elderly adults with musculoskeletal pain.
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Reliability of a Smartphone Goniometric Application in the Measurement of Hip Range of Motion Among Experienced and Novice Clinicians. J Sport Rehabil 2021; 30:969-972. [PMID: 33418537 DOI: 10.1123/jsr.2020-0165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/15/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Deficits in the hip range of motion are associated with hip and groin injuries. Accurate and reliable goniometric measurements are important in identifying those at risk of injury and determining the efficacy of treatment interventions. Smartphone goniometric applications are regularly used to assess joint ranges of motion; however, there is limited knowledge on the reliability of this method in relation to the hip, particularly between clinicians with different levels of experience. OBJECTIVE To determine the intratester and intertester reliability of a smartphone clinometer application for the assessment of hip goniometric measurements in healthy volunteers by an experienced and novice clinician. DESIGN Reliability study. SETTING University Athletic Therapy facility. PARTICIPANTS Physically active, university students. MAIN OUTCOME MEASURES The study determined the intra- and intertester (experienced vs novice clinician) reliability of goniometric measurements of the hip joint (modified Thomas test and seated hip internal and external rotation) using a smartphone goniometric application. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change at a 95% confidence interval were used to assess reliability. RESULTS Goniometric measurements demonstrated good to excellent relative intratester reliability for the modified Thomas test (ICC = .94), external rotation (ICC = .93-.95), and internal rotation (ICC = .80-.81). Intertester reliability for expert and novice clinicians was also excellent for the modified Thomas test (ICC = .98), external rotation (ICC = .95), and internal rotation (ICC = .92). Intratester and intertester standard error of measurement and minimal detectable change at 95% confidence interval values were similar for both testers and ranged from 1.9° to 3.6° and 5° to 10.1° and from 1.1° to 2.3° and 2.9° to 6.5°, respectively. CONCLUSION Smartphone-based goniometric measurements of hip range of motion have high intratester and intertester reliability for novice and expert clinicians. It may be a useful, simple, and inexpensive resource for clinicians.
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Grazette N, McAllister S, Ong CW, Sunderland C, Nevill ME, Morris JG. Reliability of a musculoskeletal profiling test battery in elite academy soccer players. PLoS One 2020; 15:e0236341. [PMID: 32702027 PMCID: PMC7377398 DOI: 10.1371/journal.pone.0236341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/04/2020] [Indexed: 11/18/2022] Open
Abstract
The study aimed to quantify the measurement error / reliability of a musculoskeletal profiling test battery administered in young, elite academy soccer players, and to examine if the order in which the test battery was administered, and who it was administered by, influenced reliability. Players (n = 75; age 12–20 years; stature 1.47–1.95 m; body mass 36–89 kg) from U-12 to U-23 age groups were assigned to either: 1) intra-rater-fixed order; 2) intra-rater-non-fixed order; 3) inter-rater-fixed order; or, 4) inter-rater-non-fixed order groups. On two separate occasions separated by 3 to 7 days, 12 raters conducted a musculoskeletal profiling test battery comprising 10 tests (Supine Medial Hip Rotation, Supine Lateral Hip Rotation, Hamstring 90/90, Prone Medial Hip Rotation [degrees]; Combined Elevation, Thoracic Rotation, Weight-Bearing Dorsiflexion, Y-Balance [centimetres]; Beighton, Lumbar Quadrant [categorical]). The measurement error / reliability for tests measured in degrees and centimetres was evaluated using the intraclass correlation (relative reliability), coefficient of variation and ratio limits of agreement (absolute reliability). Intraclass correlations varied from 0.04 (“poor”) to 0.95 (“excellent”), coefficient of variation from 2.9 to 43.4%, and the ratio limits of agreement from 1.058 (*/÷ 1.020) to 2.026 (*/÷ 1.319) for the tests measured in degrees and centimetres. The intraclass correlation, coefficient of variation and ratio limits of agreement were smallest for five out of eight tests measured in degrees and centimetres when the tests were administered in an intra-rater-fixed test order. These findings emphasise that different testing methods, and the administration of a musculoskeletal profiling test battery using a less than optimal design, will influence measurement error and hence test reliability. These observations need to be considered when investigating musculoskeletal function and age, injury, training or asymmetry in young, elite academy soccer players.
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Affiliation(s)
- Neval Grazette
- Department of Sport Science, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
| | - Scot McAllister
- Performance Services and Applied Research, Global Football, City Football Group, Manchester, United Kingdom
| | - Chin Wei Ong
- Performance Services and Applied Research, Global Football, City Football Group, Manchester, United Kingdom
| | - Caroline Sunderland
- Department of Sport Science, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
| | - Mary E. Nevill
- Department of Sport Science, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
| | - John G. Morris
- Department of Sport Science, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, United Kingdom
- * E-mail:
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Tabatabaiee A, Takamjani IE, Sarrafzadeh J, Salehi R, Ahmadi M. Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome. Muscle Nerve 2019; 60:558-565. [PMID: 31415092 DOI: 10.1002/mus.26671] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. METHODS Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. RESULTS At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. DISCUSSION The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.
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Affiliation(s)
- Abbas Tabatabaiee
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Adult spinal deformity and its relationship with hip range of motion: a cohort study of community-dwelling females. Spine J 2019; 19:1202-1209. [PMID: 30769092 DOI: 10.1016/j.spinee.2019.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity affects lower extremity alignment with compensation in joint range of motion (ROM) and alignment of the hip. PURPOSE To investigate the relationship between sagittal spinopelvic alignment and the ROM of the hip joint and the femoral oblique angle (FOA). STUDY DESIGN Cross-sectional, observational cohort study of community-dwelling Japanese women. METHODS The study group included 158 women, enrolled in our ongoing prospective cohort study, with upright spine radiographs and physical measurements obtained for all participants. Radiographic spinopelvic parameters included measurement of thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope, pelvic incidence, and pelvic tilt (PT). FOA parameters were measured on hip radiographs and hip ROM included external and internal rotation and extension. The association between spinopelvic parameters, the FOA, and hip joint ROM was evaluated using Spearman's correlation analysis. RESULTS External rotation of the hip was correlated with LL (R=0.179, p=.024), PT (R=-0.273, p=.001) and SVA (R=-0.215, p=.007), with the FOA being correlated with the SVA (R=0.502, p<.001). CONCLUSIONS The decrease in hip external rotation with adult spinal deformity might reflect a structural modification in spinopelvic alignment. An increase in FOA was associated with an increase in SVA, indicative of a sagittal malalignment in the decompensated phase of adult spinal deformity.
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