Can parameters of the helical axis be measured reliably during active cervical movements?

Convex hull area (CHA) and mean angle (MA) have been proposed to describe the behaviour of the helical axis during joint kinematics. This study investigates the intra- and inter-session reliability of CHA and MA during active movements of the cervical spine. Twenty-seven healthy volunteers (19 women) aged 23 ± 2.8 years participated. Each volunteer was tested on two sessions. All participants were instructed to perform the following active movements of the cervical spine: rotation, flexion/extension and lateral bending, each performed to full range and repeated ten consecutive times. Cervical movements were registered with an electromagnetic tracking system. For each participant, each movement and each session, range of motion (ROM), CHA and MA were extracted. ROM showed high intra- and inter-session reliability during all cervical spine movements using this method. Overall, the intra- and inter-session reliability of the helical axis parameters varied depending on the movement direction and ranged from fair to almost perfect. The intra- and inter-session reliability of CHA and MA were almost perfect during rotation whereas the intra- and inter-session reliability of CHA was substantial during lateral bending and intra- and inter-session reliability of MA ranged from fair to substantial during flexion/extension and lateral bending. This is the first study to evaluate the reliability of helical axis measures during active movements of the cervical spine. The results show that CHA and MA are promising descriptors of cervical kinematics which could be applied in future studies to evaluate neck function in patients with cervical spine disorders

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization

Perceived pain extent is not associated with widespread pressure pain sensitivity, clinical features, related-disability, anxiety, or depression in women with episodic migraine

Objective: People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related-disability and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related-disability in women with episodic migraine. Methods: Seventy-two women with episodic migraine completed pain drawings which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds (PPT) were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extra-trigeminal area) and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine relateddisability (migraine disability assessment questionnaire, MIDAS), anxiety and depression (Hospital Anxiety-Depression Scale, HADS) were also assessed. Spearman rho correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes. Results: No significant associations were observed between pain extent and PPTs in trigeminal, extra-trigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression and migraine related-disability. Conclusions: Pain extent within the trigemino-cervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.pre-print764 K

Patella Alta in a Patient with Recurrent Patellar Dislocation

The patient was a 26-year-old man who was referred to a physical therapist by an orthopedic surgeon for the management of recurrent bilateral patellar dislocations. The patient reported a high rate of dislocation events in the right knee and the last episode, one month before, involved both the patellas.The patient was a mechanic and the high activity level at the work place involved especially kneel positions.At the initial evaluation, the patient complained about moderate pain on the anterior surface of the right knee and fear of new events of dislocation.Visual inspection revealed a bilateral valgus knee (Figure1) and, during walking, an inability to bear weight on the right leg. Assessment of the ankle region reveal a pronated position of both ankles. No other restriction or limitation were noted.</p

A comparative analysis of Donald Bradman and Steven Smith: what are their secrets?

There has been growing evidence on the batting backlift technique in cricket at varying levels of cricket ability and the way in which batsmen direct or manoeuvre their bat in various ways. Most recently, there has been elevated awareness and discussion around the technique of Steven Smith. To an extent, there has been some comparison and reference been made to Sir Donald Bradman. Both Donald Bradman and Steven Smith have exhibited techniques and movements at the crease which many regard as ‘unorthodox’ or ‘unnatural’. This paper compares each of the batting technique components of both batsmen. The paper describes that both Bradman and Smith held their bat with an open grip which allowed them to hit the ball in most scoring areas of the field. The most common element that both batsmen demonstrate is a backlift that is directed towards the gulley or point region, otherwise known as the rotary method of batting, which is contrary to most of the coaching literature. Future research would require objective measures on Steven Smith to fully understand the kinetics and kinematics associated with his batting technique. The variances of performance averages across other formats (one-day internationals and 20-20 cricket) must be noted

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

ObjectiveThis study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness.DesignReliability and construct validity study.MethodsForty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0–3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test.ResultsIntra-rater reliability was very high ICC2,k 0.87–0.98. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC2,k of 0.76–0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC2,k of 0.70–0.89. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions.ConclusionMyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties