ILIOTIBIAL BAND SYNDROME INJURED RUNNERS INCREASE FLEXIBILITY USING SOFT TISSUE MOBILIZATION AND INCREASE FUNCTIONAL STRENGTH USING A HEAT PACK-IMPLICATIONS FOR FASTER RECOVERY

The purpose of this study was to quantify the effects of two independent treatments, soft tissue mobilization and a localized heat pack, upon iliotibial band syndrome injured runner. Iliotibial band injured runners (n=5) who were actively seeking soft tissue mobilization as a treatment were recruited. These runners received one of three randomized treatments during three consecutive visits - (1) soft tissue mobilization (2) an iliotibial band isolating heat pack (3) rest. Iliotibial band flexibility and functional abductor strength measures were taken before and after each treatment. Flexibility was quantified by determining the hip and knee abduction moments generated during the iliotibial band stretch. Each active treatment resulted in significant changes when compared to the treatment of rest. Soft tissue mobilization increased flexibility at the hip and knee while the heat pack increased functional abductor strength

BIOMECHANICAL INJURY PREDICTORS FOR MARATHON RUNNERS : STRIDING TOWARDS ILIOTIBIAL BAND SYNDROME INJURY PREVENTION

The purpose of this study was to prospectively analyze a large group of marathon runners (n=20) and test for biomechanical determinants of running injuries. The opportunity to prospectively follow runners of organized marathon training teams allowed for testing of the hypothesis that functional biomechanics may lead to iliotibial band syndrome (ITBS). Each runner was gait tested prior to developing any injuries. Injury predictors were generated by comparing those legs which eventually got ITBS injuries (n=7) with those legs that were injury free (n=33). Higher peak hip adduction moments (

Inter-Rater Agreement and Validity of a Tackling Performance Assessment Scale in Youth American Football

Background: Long term neurologic injury and concussion have been identified as risks from participation in American football. Altering tackling form has been recommended to reduce the risk of neurologic injury caused by head accelerations when tackling. The purpose of this research is to determine the inter-rater agreement and validity of the Qualitative Youth Tackling System (QYTS), a six-item feedback scale to correct tackling form, when utilized by novice and expert raters. Hypothesis: Experienced raters will have higher levels of agreement with each other and with motion capture when compared to novice raters. Methods: Both novice and experienced raters viewed video of youth athletes (ages 9-13) tackling a dummy in a laboratory setting along. The raters identified successful performance according to a binary rating scale for each component. Analysis of both the raters\u27 agreement with each other and with an objective motion capture measure were completed. Results: Fliess\u27 Kappa measures between all raters were found to be moderate for head placement (k=.48), fair for cervical extension (k=.38), trunk inclination (k=.37), shoulder extension (k=.27) and step length (k=.29), and there was no agreement for pelvic height (k=.-16). When compared to the dichotomized validation measures of each of the five components provided by the motion capture system the average Cohen\u27s Kappa agreement was substantial for pelvic height (k=.63), fair for step length (k=.34), cervical extension (k=.40), trunk inclination (k=.35), and slight for shoulder extension (k=.16). The experienced raters out-performed the novice raters in all categories. Conclusion: The results of this study indicate that skilled raters are better able to identify the movement patterns included in the QYTS when compared to a validation measure as well have higher rates of interrater agreement than novice raters. Level of Evidence: 3

The Effect of Tackling Training on Head Accelerations in Youth American Football

Background: Many organizations have introduced frameworks to reduce the incidence of football related concussions through proper equipment fitting, coach education, and alteration of tackling technique. Purpose: The purpose of this study was to examine the effects of training in a vertical, head up tackling style on the number of head accelerations experienced while tackling in a controlled laboratory situation. The authors hypothesized that training in a head up tackling technique would reduce the severity of head acceleration experienced by participants. Design: Controlled Laboratory Study. Methods: Twenty-four participants (11.5 ± 0.6 years old, 60.5 ± 2.2 in, 110 ± 18.4 lbs.) with previous playing experience completed a one-day training session on tackling technique utilizing a tackling dummy. A subgroup of these participants completed an additional two days of training with a 48 hour retention test. Head accelerations were analyzed at baseline and end of training. Feedback consisted of verbal feedback utilizing the Qualitative Youth Tackling Scale (QYTS) and video tackling playback. Results: A significant reduction in the number of peak linear head accelerations over 10 g and peak rotational head accelerations over 1885 deg/s² were found in dummy tackling after training in both the one day and three day training regimens. A significant change in QYTS tackling form score was found between pretest and post-test (p=0.004). Participants with larger steps had a 2.28, 4.42 and 4.14 increased odds ratio of sustaining head accelerations over 10, 15 and 20 g respectively. Conclusions: Training in a vertical, head up tackling style decreased the number of head accelerations over threshold values sustained while tackling; decreased step length may be the driving factor in the effectiveness of this tackling form. Level of Evidence: Level 3

Normative Functional Performance Values in High School Athletes: The Functional Pre-Participation Evaluation Project

Context: The fourth edition of the Preparticipation Physical Evaluation recommends functional testing for the musculoskeletal portion of the examination; however, normative data across sex and grade level are limited. Establishing normative data can provide clinicians reference points with which to compare their patients, potentially aiding in the development of future injury-risk assessments and injury-mitigation programs. Objective: To establish normative functional performance and limb-symmetry data for high school-aged male and female athletes in the United States. Design: Cross-sectional study. Setting: Athletic training facilities and gymnasiums across the United States. Patients or Other Participants: A total of 3951 male and female athletes who participated on high school-sponsored basketball, football, lacrosse, or soccer teams enrolled in this nationwide study. Main Outcome Measure(s): Functional performance testing consisted of 3 evaluations. Ankle-joint range of motion, balance, and lower extremity muscular power and landing control were assessed via the weight-bearing ankle-dorsiflexion–lunge, single-legged anterior-reach, and anterior single-legged hop-for-distance (SLHOP) tests, respectively. We used 2-way analyses of variance and χ2 analyses to examine the effects of sex and grade level on ankle-dorsiflexion–lunge, single-legged anterior-reach, and SLHOP test performance and symmetry. Results: The SLHOP performance differed between sexes (males = 187.8% ± 33.1% of limb length, females = 157.5% ± 27.8% of limb length; t = 30.3, P \u3c .001). A Cohen d value of 0.97 indicated a large effect of sex on SLHOP performance. We observed differences for SLHOP and ankle-dorsiflexion–lunge performance among grade levels, but these differences were not clinically meaningful. Conclusions: We demonstrated differences in normative data for lower extremity functional performance during preparticipation physical evaluations across sex and grade levels. The results of this study will allow clinicians to compare sex- and grade-specific functional performances and implement approaches for preventing musculoskeletal injuries in high school-aged athletes

Differential expression of collectins in human placenta and role in inflammation during spontaneous Labor.

© 2014 Yadav et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Collectins, collagen-containing Ca2+ dependent C-type lectins and a class of secretory proteins including SP-A, SP-D and MBL, are integral to immunomodulation and innate immune defense. In the present study, we aimed to investigate their placental transcript synthesis, labor associated differential expression and localization at feto-maternal interface, and their functional implication in spontaneous labor. The study involved using feto-maternal interface (placental/decidual tissues) from two groups of healthy pregnant women at term (≥37 weeks of gestation), undergoing either elective C-section with no labor ('NLc' group, n = 5), or normal vaginal delivery with spontaneous labor ('SLv' group, n = 5). The immune function of SP-D, on term placental explants, was analyzed for cytokine profile using multiplexed cytokine array. SP-A, SP-D and MBL transcripts were observed in the term placenta. The 'SLv' group showed significant up-regulation of SP-D (p = 0.001), and down-regulation of SP-A (p = 0.005), transcripts and protein compared to the 'NLc' group. Significant increase in 43 kDa and 50 kDa SP-D forms in placental and decidual tissues was associated with the spontaneous labor (p<0.05). In addition, the MMP-9-cleaved form of SP-D (25 kDa) was significantly higher in the placentae of 'SLv' group compared to the 'NLc' group (p = 0.002). Labor associated cytokines IL-1α, IL-1β, IL-6, IL-8, IL-10, TNF-α and MCP-1 showed significant increase (p<0.05) in a dose dependent manner in the placental explants treated with nSP-D and rhSP-D. In conclusion, the study emphasizes that SP-A and SP-D proteins associate with the spontaneous labor and SP-D plausibly contributes to the pro-inflammatory immune milieu of feto-maternal tissues.Funding provided by BT/PR15227/BRB/10/906/2011) Department of Biotechnology (DBT), Government of India http://dbtindia.nic.in/index.asp (TM) and Indian Council of Medical Research (ICMR) Junior Research Fellowship (JRF)/Senior Research Fellowship (SRF), Government of India, www.icmr.nic.in (AKY)

Comparative assessment of bone pose estimation using point cluster technique and OpenSim

Estimating the position of the bones from optical motion capture data is a challenge associated with human movement analysis. Bone pose estimation techniques such as the Point Cluster Technique (PCT) and simulations of movement through software packages such as OpenSim are used to minimize soft tissue artifact and estimate skeletal position; however, using different methods for analysis may produce differing kinematic results which could lead to differences in clinical interpretation such as a misclassification of normal or pathological gait. This study evaluated the differences present in knee joint kinematics as a result of calculating joint angles using various techniques. We calculated knee joint kinematics from experimental gait data using the standard PCT, the least squares approach in OpenSim applied to experimental marker data, and the least squares approach in OpenSim applied to the results of the PCT algorithm. Maximum and resultant RMS differences in knee angles were calculated between all techniques. We observed differences in flexion/extension, varus/ valgus, and internal/external rotation angles between all approaches. The largest differences were between the PCT results and all results calculated using OpenSim. The RMS differences averaged nearly 5 for flexion/extension angles with maximum differences exceeding 15 . Average RMS differences were relatively small (&lt; 1.08 ) between results calculated within OpenSim, suggesting that the choice of marker weighting is not critical to the results of the least squares inverse kinematics calculations. The largest difference between techniques appeared to be a constant offset between the PCT and all OpenSim results, which may be due to differences in the definition of anatomical reference frames, scaling of musculoskeletal models, and/or placement of virtual markers within OpenSim. Different methods for data analysis can produce largely different kinematic results, which could lead to the misclassification of normal or pathological gait. Improved techniques to allow non-uniform scaling of generic models to more accurately reflect subject-specific bone geometries and anatomical reference frames may reduce differences between bone pose estimation techniques and allow for comparison across gait analysis platforms

A new perspective on transient characteristics of quiet stance postural control.

Postural control provides insight into health concerns such as fall risk but remains relatively untapped as a vital sign of health. One understudied aspect of postural control involves transient responses within center of pressure (CoP) data to events such as vision occlusion. Such responses are masked by common whole-trial analyses. We hypothesized that the transient behavior of postural control would yield unique and clinically-relevant information for quiet stance compared to traditionally calculated whole-trial CoP estimates. Three experiments were conducted to test different aspects of this central hypothesis. To test whether transient, epoch-based characteristics of CoP estimates provide different information than traditional whole-trial estimates, we investigated correlations between these estimates for a population of young adults performing three 60-second trials of quiet stance with eyes closed. Next, to test if transient behavior is a result of sensory reweighting after eye closure, we compared transient characteristics between eyes closed and eyes open conditions. Finally, to test if there was an effect of age on transient behavior, we compared transient characteristics during eyes closed stance between populations of young and older adults. Negligible correlations were found between transient characteristics and whole-trial estimates (p>0.08), demonstrating limited overlap in information between them. Additionally, transient behavior was exaggerated during eyes closed stance relative to eyes open (p<0.044). Lastly, we found that transient characteristics were able to distinguish between younger and older adults, supporting their clinical relevance (p<0.029). An epoch-based approach captured unique and potentially clinically-relevant postural control information compared to whole-trial estimates. While longer trials may improve the reliability of whole-trial estimates, including a complementary assessment of the initial transient characteristics may provide a more comprehensive characterization of postural control

Lumbopelvic neuromuscular training and injury rehabilitation: a systematic review

The aim of this systematic review was to assess the evidence for lumbopelvic neuromuscular training (LNMT) in individuals after musculoskeletal (MSK) injury. A literature search of PubMed and EMBASE databases was performed for English studies from January 1990 to March 2012. Search terms including and related to trunk, core, stability, injury, and LNMT were used. All studies directly involving LNMT for MSK injuries were reviewed by 2 authors. These articles were assessed based on the inclusion criteria and if appropriate selected for further analysis. Expert opinion, review articles, and articles involving non-MSK injuries were excluded. Four authors then scored the selected articles for methodological quality. A total of 2312 articles were initially identified. Twenty-nine articles met the inclusion criteria for review and were divided into categories of lower extremity (LE), lumbar, and upper extremity (UE). No trials involving the UE met the inclusion criteria. Data including subject demographics (age, height, weight, gender, etc), injury type, intervention type, and outcome measurements were extracted from the relevant articles. A variety of baseline and follow-up scores were extracted including pain levels, patient satisfaction, disability questionnaires, and other functional outcomes. Two out of 3 LE randomized controlled trials (RCTs) and 9/26 lumbar RCTs were rated with high methodological quality based on the scoring system described by van Tulder et al. The average quality score for the LE RCTs was 6.3 (range = 4-9) and for the lumbar RCTs was 5.1 (range = 2-9). The evidence for the effectiveness of the 3 LE studies was rated as conflicting, whereas 24 lumbar studies demonstrated moderate-to-strong evidence. Unfortunately, heterogeneity of populations, interventions, and outcomes precluded a quantitative meta-analysis and specific clinical recommendations. High-quality evidence is lacking to make specific clinical recommendations for or against the use of LNMT in the rehabilitation of individuals after MSK injury. Based on this review, future research should focus on well-defined, homogeneous populations, interventions specifically addressing neuromuscular activation of the lumbopelvic musculature, patient-specific clinical outcomes, measures of motor control, biomechanics, and return to specific activities