3-D Analysis of a Functional Reach Test in Subjects With Functional Ankle Instability

CONTEXT: 3-D kinematics and kinetics of the lower extremity during the Star Excursion Balance Test (SEBT) have not been examined in FAI subjects. Additionally, the effects of Kinesio® tape use in subjects with functional ankle instability (FAI) during functional tasks is uninvestigated. OBJECTIVE: To determine if lower extremity kinematics and kinetics differed in FAI subjects using Kinesio® tape during maximal SEBT reach. SUBJECTS: Twenty subjects with FAI (Age=24.2±3.8yrs; Ht=169±11.6cm; Wt=69±12.4kg) and twenty uninjured subjects (Age=25.7±5.6yrs; Ht=170.1.4±8.8cm; Wt=69.9±10.5kg) with no history of ankle sprain. FAI was operationally defined as repeated episodes of ankle “giving way” and/or ankle “rolling over”, regardless of neuromuscular deficits or pathologic laxity. All FAI subjects scored \u3c 26 on the Cumberland Ankle Instability Tool. METHODS: SEBT reaches included the anteromedial, medial, and posteromedial directions. FAI subjects used their unstable side as the stance leg, while control subjects were side-matched to the FAI group. The stance leg ankle was taped using 1) Kinesio® tape and the Kinesio taping method (Kinesio method); 2) white linen tape with the Kinesio method; 3) Kinesio® tape along the distal peroneals tendons (lateral method); 4) white tape with the lateral method. Three-dimensional lower extremity kinematics, kinetics, and force plate data were collected during SEBT performance. A repeated measures ANOVA analyzed the effects of group, tape, tape method, and reach direction on all variables (α=0.05). Tukey HSD post-hoc analyses were performed for significant interactions. RESULTS: Normalized reach distance was not significantly different between groups in any direction (F2,76=1.16, P=.32). A significant four-way interaction for tape, method, direction, and group (F2,72=3.874, P=.03) was found. Post-hoc testing showed FAI subjects exhibited hip abduction while control subjects used hip adduction (Condition 1: .65±8.23° vs. -2.14±8.51°; Condition 2: 1.29±7.71° vs. -1.75±8.29°; Condition 3: 1.08±8.39° vs. -1.88±18.33°; Condition 4: 2.13±7.62° vs. -1.54±6.61°). Additionally, a significant difference in FAI subjects’ hip abduction angles between the white tape/Kinesio method (.65±8.23°) and Kinesio tape/Kinesio method (1.08±8.39°) was found. Conclusions: These results indicate that FAI subjects’ movement strategies differ from those of uninjured subjects. Furthermore, the use of Kinesio® tape at a distal joint can alter proximal joint movement in subjects with FAI

Muscle Strength and Qualitative Jump-Landing Differences in Male and Female Military Cadets: The Jump-ACL Study

Recent studies have focused on gender differences in movement patterns as risk factors for ACL injury. Understanding intrinsic and extrinsic factors which contribute to movement patterns is critical to ACL injury prevention efforts. Isometric lower- extremity muscular strength, anthropometrics, and jump-landing technique were analyzed for 2,753 cadets (1,046 female, 1,707 male) from the U.S. Air Force, Military and Naval Academies. Jump- landings were evaluated using the Landing Error Scoring System (LESS), a valid qualitative movement screening tool. We hypothesized that distinct anthropometric factors (Q-angle, navicular drop, bodyweight) and muscle strength would predict poor jump-landing technique in males versus females, and that female cadets would have higher scores (more errors) on a qualitative movement screen (LESS) than males. Mean LESS scores were significantly higher in female (5.34 ± 1.51) versus male (4.65 ± 1.69) cadets (p < 0.001). Qualitative movement scores were analyzed using factor analyses, yielding five factors, or “patterns”, contributing to poor landing technique. Females were significantly more likely to have poor technique due to landing with less hip and knee flexion at initial contact (p < 0.001), more knee valgus with wider landing stance (p < 0. 001), and less flexion displacement over the entire landing (p < 0.001). Males were more likely to have poor technique due to landing toe-out (p < 0.001), with heels first, and with an asymmetric foot landing (p < 0.001). Many of the identified factor patterns have been previously proposed to contribute to ACL injury risk. However, univariate and multivariate analyses of muscular strength and anthropometric factors did not strongly predict LESS scores for either gender, suggesting that changing an athlete’s alignment, BMI, or muscle strength may not directly improve his or her movement patterns

Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program

Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk

The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics

Seven Steps for Developing and Implementing a Preventive Training Program: Lessons Learned from JUMP-ACL and Beyond

Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs

Association between anesthetic dose and technique and oncologic outcomes after surgical resection of non-small cell lung cancer

Objectives: Because of the biologic effects of volatile anesthetics on the immune system and cancer cells, it has been hypothesized that their use during non-small cell lung cancer (NSCLC) surgery may negatively affect cancer outcomes compared with total intravenous anesthesia (TIVA) with propofol. The present study evaluated the relationship between anesthetic technique and dose and oncologic outcome in NSCLC surgery. Design: Retrospective cohort study. Setting: Surgical records collated from a single, tertiary care hospital and combined with the Scottish Cancer Registry and continuously recorded electronic anesthetic data. Participants: Patients undergoing elective lung resection for NSCLC between January 2010 and December 2014. Interventions: The cohort was divided into patients receiving TIVA only and patients exposed to volatile anesthetics. Measurements and Main Results: Final analysis included 746 patients (342 received TIVA and 404 volatile anesthetic). Kaplan-Meier survival curves with log-rank testing were drawn for cancer-specific and overall survival. No significant differences were demonstrated for either cancer-specific (p = 0.802) or overall survival (p = 0.736). Factors influencing survival were analyzed using Cox proportional hazards modeling. Anesthetic type was not a significant predictor for cancer-specific or overall survival in univariate or multivariate Cox analysis. Volatile anesthetic exposure was quantified using area under the end-tidal expired anesthetic agent versus time curves. This was not significantly associated with cancer-specific survival on univariate (p = 0.357) or multivariate (p = 0.673) modeling. Conclusions: No significant relationship was demonstrated between anesthetic technique and NSCLC survival. Whether a causal relationship exists between anesthetic technique during NSCLC surgery and oncologic outcome warrants definitive investigation in a prospective, randomized trial

Seven Steps for Developing and Implementing a Preventive Training Program: Lessons Learned from JUMP-ACL and Beyond

Musculoskeletal injuries during military and sport-related training are common, costly, and potentially debilitating. There is a need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. This article proposes 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions

Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review

Background: Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies.Objective: To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations.Materials and methods: 5 electronic databases were systematically searched. Studies selected included original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. 2 independent authors assessed the quality (Downs and Black (DB) criteria) and level of evidence (Oxford Centre of Evidence-Based Medicine model).Results: Of 4361 potential studies, 17 were included. The majority were low-quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). 4 studies considered inter-relationships between risk factors, 7 reported diagnostic accuracy and none tested an intervention programme targeting individuals identified as high risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations.Conclusions: Future research should focus on high-quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating preparticipation screening and LE injury prevention programmes through high-quality randomised controlled trials targeting individuals at greater risk of injury based on screening tests with validated test properties.<br/