The Effects of TMR® Fab 6 on Hamstring Flexibility in Healthy Subjects; An Exploratory Observational Investigation.

Background: Stretching programs are designed to improve hamstring flexibility by attempting to mechanically increase the length of the target tissue. However, other manual treatment approaches such as those utilized in Total Motion Release (TMR®), could be beneficial by identifying body asymmetries to assess and treat soft tissue impairments leading to diminished extensibility. Purpose: The purpose of this study was to determine the effectiveness of the TMR® Fab 6 assessment and treatment to increase hamstring flexibility in healthy participants following one session of TMR®. Study Design: Observational Cohort study. Methods: A convenience sample of 20 healthy participants (10 males, 10 females) were recruited from three institutions. Following collection of demographic information and a brief medical history, each participant performed a five minute warm-up on the stationary bike at a moderate intensity (80-90 RPMs) followed immediately by the bilateral performance of the Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) to assess hamstring muscle length. Participants were randomly placed in the TMR® or control group. The TMR® group completed the "Fab 6" evaluation and treatment, while the control group performed one repetition of standing active hip flexion every 30-seconds for 15-minutes with both knees in full extension. Upon completion of treatment, control and TMR® groups were immediately re-evaluated on the AKET and the PSLR in the same order and fashion as baseline testing. Participants were asked to return in 24-hours for the same objective measurements as previously described. Results: A significant time by group interaction was identified across all variables (p ≤ 0.001) for AKET and PSLR except the PSLR preferred leg from post-treatment to 24hr follow-up. The most significant increase in the AKET occurred in the TMR® group between baseline and post-treatment of the non-preferred leg (12.15°±2.94) when compared to the control group (7.15°±1.56). Conclusion: The results of the study suggest that implementing a regionally interdependent treatment approach like TMR® results in significant improvements in hamstring extensibility and hip ROM compared to the control group. Level of evidence: 3.

Longitudinal Analysis and Latent Growth Modeling of the Modified Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR).

The Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) was developed as a short-form survey to measure progress after total hip arthroplasty (THA). However, the longitudinal validity of the scale structure pertaining to the modified five-item HOOS-JR has not been assessed. Therefore, the purpose of this study was to evaluate the structural validity, longitudinal invariance properties, and latent growth curve (LGC) modeling of the modified five-item HOOS-JR in a large multi-site sample of patients who underwent a THA. A longitudinal study was conducted using data from the Surgical Outcome System (SOS) database. Confirmatory factor analyses (CFAs) were conducted to assess the structural validity and longitudinal invariance across five time points. Additionally, LGC modeling was performed to assess the heterogeneity of the recovery patterns for different subgroups of patients. The resulting CFAs met most of the goodness-of-fit indices (CFI = 0.964-0.982; IFI = 0.965-0.986; SRMR = 0.021-0.035). Longitudinal analysis did not meet full invariance, exceeding the scalar invariance model (CFIDIFF = 0.012; χ2DIFF test = 702.67). Partial invariance requirements were met upon release of the intercept constraint associated with item five (CFIDIFF test = 0.010; χ2DIFF = 1073.83). The equal means model did not pass the recommended goodness-of-fit indices (CFIDIFF = 0.133; χ2DIFF = 3962.49). Scores significantly changed over time, with the highest scores identified preoperatively and the lowest scores identified at 2- and 3-years postoperatively. Upon conclusion, partial scalar invariance was identified within our model. We identified that patients self-report most improvements in their scores within 6 months postoperatively. Females reported more hip disability at preoperative time points and had faster improvement as measured by the scores of the modified five-item HOOS-JR.

Tissue Flossing: A Commentary on Clinical Practice Recommendations.

Tissue flossing is an emerging myofascial intervention used by sports medicine professionals with a growing body of research evidence. Sports medicine professionals may use tissue flossing to increase myofascial mobility, improve joint ROM, enhance athletic performance, and reduce pain. Despite the increasing use, there is no consensus on clinical practice recommendations for this intervention. The purpose of this commentary is to discuss proposed clinical practice recommendations for tissue flossing and to encourage sports medicine professionals and researchers to contribute their expertise to further develop best practices. Level of Evidence: 5.

Psychometric analysis of the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR).

Objective: Centers for Medicare and Medicaid Services (CMS) has requested hospitals collect and report patient-reported outcomes (PROs) beginning in 2024 including the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR). However, scale structural validity of the HOOS-JR has minimally been assessed. The purpose of this study was to assess internal consistency, structural validity, and multi-group invariance properties of the HOOS-JR in a large sample of patients who underwent a total hip arthroplasty (THA). Methods: A cross-sectional study using the Surgical Outcomes System was retrospectively queried for patients who underwent a THA. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. A confirmatory factor analysis (CFA) was performed on the HOOS-JR using a priori cut-off values. Multi-group invariance testing was also performed on the sample of patients across sex and age groups. Results: Internal consistency was acceptable for 6-item (alpha â€‹= â€‹0.88; omega â€‹= â€‹0.88) and 5-item (alpha â€‹= â€‹0.86; omega â€‹= â€‹0.86) HOOS-JR. The one-factor, 6-item CFA did not meet the recommended fit indices. The one-factor, 5-item CFA had acceptable fit for the sample data. Invariance testing criteria were met between the age groups; however, scalar invariance was not met for sex. Conclusion: The 6-item HOOS-JR did not meet contemporary model fit indices indicating that scale refinement is warranted. The 5-item met most goodness-of-fit indices and invariance criteria. However, further scale refinement may be warranted as localized fit issues were identified.

The Effects of Light Pressure Instrument-Assisted Soft Tissue Mobilization at Different Rates on Grip Strength and Muscle Stiffness in Healthy Individuals.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial treatment utilized by health care professionals. Currently, there is a lack of research on the effects of a light pressure IASTM treatment on the forearm region. The purpose of this study was to explore the effects of a light pressure IASTM technique at different application rates on grip strength and muscle stiffness. This study was considered exploratory with the goal of establishing methodology for future controlled studies. DESIGN: Observational pretest and posttest clinical study. METHODS: Twenty-six healthy adults underwent one light pressure IASTM treatment to their dominant forearm muscles. Participants were allocated to 2 groups of 13 based upon treatment rate: 60 beats per minute and 120 beats per minute. Participants were tested pretreatment and posttreatment for grip strength and tissue stiffness via diagnostic ultrasound. One-way analyses of covariance were used to assess group differences posttreatment for grip strength and tissue stiffness. RESULTS: Statistically significant posttreatment changes for grip strength and tissue stiffness were not found. Despite the nonstatistical significance, there were small decreases in grip strength and tissue stiffness. Faster (120 beats/min) IASTM application may have produced clinically meaningful decreases in grip strength along with a small decrease in tissue stiffness. CONCLUSIONS: This report helps to establish methodology for future controlled studies on this topic. Sports medicine professionals should consider these results as exploratory and interpret them with caution. Future research is needed to confirm these findings and begin to postulate possible neurophysiological mechanisms.

Confirmatory Factor Analysis of the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Associated Sub-scales.

Background: Hip Disability and Osteoarthritis Outcome Score (HOOS), HOOS-Joint Replacement (JR), HOOS Physical Function (PS), and HOOS-12 item scale have been suggested as reliable and valid instruments for assessing hip disability. However, factorial validity, invariance across subgroups, and repeated measures of the scale across different populations have not been well supported in the literature. Purpose: The primary study objectives were to: (1) assess model fit and psychometric properties of the original 40-item HOOS scale, (2) assess model fit of the HOOS-JR, (3) assess model fit of the HOOS-PS, and (4) assess model fit of the HOOS-12. A secondary objective was to perform multigroup invariance testing across physical activity level and hip pathology subgroups for models that met recommended fit indices. Study Design: Cross-Sectional Study. Methods: Individual confirmatory factor analyses (CFAs) were conducted for the HOOS, HOOS-JR, HOOS-PS, and HOOS-12. Additionally, multigroup invariance testing (i.e., activity level, injury type) was conducted on the HOOS-JR and HOOS-PS. Results: Model fit indices did not meet contemporary recommendations for the HOOS and the HOOS-12. Model fit indices for the HOOS-JR and the HOOS-PS met some, but not all, contemporary recommendations. Invariance criteria was met for the HOOS-JR and HOOS-PS. Conclusion: The scale structure of the HOOS and HOOS-12 were not supported; however, preliminary evidence to support the scale structure of the HOOS-JR and HOOS-PS was found. Clinicians and researchers who utilize the scales should do so with caution due to their limitations and untested properties until further research establishes the full psychometric properties of these scales and recommendations for their continued use.

The Efficacy of the Mulligan Concept to Treat Meniscal Pathology: A Systematic Review.

Background: Meniscal pathologies are common knee injuries and arthroscopic surgery is the current accepted gold standard for treatment. However, there is evidence to support the use of the Mulligan Concept (MC) Mobilization with Movement (MWM) for meniscal pathologies including the 'Squeeze' technique, tibial internal rotation (IR), and tibial external rotation (ER). Hypothesis/Purpose: The purpose of this systematic review was to critically appraise the literature to investigate the effectiveness of MC MWMs for meniscal lesions on patient reported pain, function, and multi-dimensional health status in patients with clinically diagnosed meniscal pathologies. Study Design: Systematic Review. Methods: A literature search was completed across multiple databases using combinations of the words "knee, function, mobilization with movement, MWM, mulligan concept, MC, meniscal pathology, meniscal derangement, and meniscal tear." Studies written within the prior 10 years that examined MC MWM techniques to treat knee meniscal injury were included. Articles that met the inclusion criteria (used MC MWM 'Squeeze' technique, tibial IR, or tibial ER for treatment of clinically diagnosed meniscal pathologies; Patient reported outcome [PRO] measures had to be used in the assessment of knee pain or function) were analyzed for quality. Randomized control trials were analyzed using the PEDro scale and the Downs & Black (D&B) checklist, case series were analyzed using the Joanna Briggs Institute (JBI) checklist, and case reports were analyzed using the CARES checklist. Results: Six articles met the inclusion criteria and were included in this review, two randomized controlled studies, two case series, and two case reports consisting of 72 subjects. All six papers included reports of improvements in pain and function that were either statistically significant or met the minimal clinically important difference (MCID). Five studies reported the Disablement in the Physically Active (DPA) scale that also demonstrated statistically significant differences or met the MCID. The MC MWM 'Squeeze' technique, tibial IR, or tibial ER demonstrated the ability to reduce pain, improve function, and improve patient perceived disability following treatment of a clinically diagnosed meniscal pathology. These studies demonstrated short term results lasting from one week to 21 weeks. Conclusion: Treatment interventions incorporating MC MWM techniques demonstrated reduction of pain and improvement in function in the short term in patients with clinically diagnosed meniscal pathologies. Level of Evidence: 2a.

Exploring Force Production Reliability across Different Levels of Clinical Experience during a Simulated One-handed Instrument-Assisted Soft Tissue Mobilization Treatment: A Pilot Study.

Background: Instrument-assisted soft tissue mobilization (IASTM) is a commonly utilized intervention for musculoskeletal pain and dysfunction. However, little is known regarding the reliability of forces applied by clinicians of different experience levels during an IASTM intervention. Purpose: The purpose of this pilot study was to assess intra-clinician reliability of IASTM force (i.e., mean normal force) during a simulated, one-handed stroke IASTM intervention across different levels of IASTM clinical experience. Design: Descriptive laboratory study. Methods: The researchers conducted a repeated measures trial in a laboratory setting with a convenience sample of ten participants who had previously completed professional IASTM training. Participants performed 15 one-handed sweeping strokes with an IASTM instrument on a skin simulant attached to a force plate for a standardized hypothetical treatment scenario. The participants performed the treatment on two separate days, 24-48 hours apart. The researchers examined the intra-rater reliability for average (mean) normal forces using Bland-Altman (BA) plots and Coefficient of Variation (CV) values. Results: The BA plot results indicated all participants (professional athletic training students = 4, athletic trainers = 6; males = 5, females = 5; age = 32.60 ± 8.71 y; IASTM experience = 3.78 ± 4.10 y), except participant D (1.9N, 190g), were consistently reliable within 1N (100g) or less of force for mean differences and within the maximum limits of agreement around 3.7N (370g). Most participants' CV scores ranged between 8 to 20% supporting reliable force application within each treatment session. Conclusion: The data indicated that IASTM trained clinicians could produce consistent forces within and across treatment sessions irrespective of clinical experience. Level of Evidence: 3.

Clinician Reliability of One-Handed Instrument-Assisted Soft Tissue Mobilization Forces During a Simulated Treatment.

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology. Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors' purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The authors' findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes.

Instrument-Assisted Soft Tissue Mobilization Forces Applied by Trained Clinicians During a Simulated Treatment.

CONTEXT: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. OBJECTIVE: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. DESIGN: Experimental. SETTING: University research laboratory. PARTICIPANTS: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). INTERVENTION: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. MAIN OUTCOME MEASURES: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. RESULTS: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. CONCLUSIONS: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

Descriptive Analysis of Forces Applied by Trained Clinicians During Two-Handed Instrument-Assisted Soft Tissue Mobilization.

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.

Clinical Practice Patterns Among Health Care Professionals for Instrument-Assisted Soft Tissue Mobilization.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) is a popular myofascial intervention used by health care professionals. OBJECTIVE: To document IASTM clinical practice patterns among health care professionals in the United States. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 853 members of the National Athletic Trainers' Association (n = 249) and the American Physical Therapy Association (n = 604). MAIN OUTCOME MEASURE(S): Responses to a 55-item electronic survey that assessed 4 areas, namely, IASTM training and experience, IASTM application, perception of IASTM in practice, and demographic information. RESULTS: Most (n = 705, 83%) of the 853 respondents used IASTM in their practice, and they had an average of 15 years of work experience. Approximately 86% (n = 731) reported completing some type of formal training, and 61% (n = 518) had completed some type of informal training. Respondents used >34 different IASTM tools. Seventy-one percent (n = 606) indicated either not knowing how to quantify the amount of force applied by the tool during treatment or not trying to quantify. Fifteen percent (n = 128) estimated a force ranging from 100 to 500g. The treatment time for a specific lesion and location ranged from 1 to ≤5 minutes, with an average total treatment time of 14.46 ± 14.70 minutes. Respondents used 31 different interventions before or after IASTM. Approximately 66% (n = 564) reported following treatment recommendations, and 19% (n = 162) described rarely or never following recommendations learned during training. A total of 94% (n = 801) recounted using some type of clinical outcome measure to assess their treatment. Cluster analysis identified 3 distinct cluster groupings among professionals, with most (89%, n = 729/818) indicating that IASTM was an effective treatment. CONCLUSIONS: This survey documented the IASTM practice patterns of health care professionals. Cluster profiles characterized group differences in IASTM training and clinical application. The gaps among research, clinical practice, and training need to be bridged to establish IASTM best practices.

Kinesiology Tape: A Descriptive Survey of Healthcare Professionals in the United States.

BACKGROUND: The existing body of kinesiology tape (KT) research reveals inconsistent results which challenges the efficacy of the intervention. Understanding professional beliefs and KT clinical application might provide insight for future research and development of evidence-based guidelines. PURPOSE: The purpose of this study was to survey and document the beliefs and clinical application methods of KT among healthcare professionals in the United States. DESIGN: Cross-sectional survey study. METHODS: A 30-question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. Professionals were also informed through a recruitment post in different private healthcare Facebook groups. RESULTS: One thousand and eighty-three respondents completed the survey. Most respondents used KT for post-injury treatment (74%), pain modulation (67%), and neuro-sensory feedback (60%). Most believed that KT stimulates skin mechanoreceptors (77%), improve local circulation (69%), and modulates pain (60%). Some respondents believed KT only created a placebo effect (40%) and use it for such therapeutic purposes (58%). Most used a standard uncut roll (67%) in black (71%) or beige (66%). Most respondents did not use any specialty pre-cut tape (83%), infused tape (99.54%), or a topical analgesic with tape (65%). The most common tape tension lengths used by respondents were 50% tension (47%) and 25% (25%) tension. Patient reported outcomes (80%) were the most common clinical measures. Most respondents provided skin prep (64%) and tape removal (77%) instructions. Some did not provide any skin prep (36%) or tape removal (23%) instruction. The average recommended times to wear KT were two to three days (60%). The maximum times ranged from two to five days (81%). CONCLUSION: This survey provides insight into how professionals use KT and highlights the gap between research and practice. Future research should address these gaps to better determine evidence-based guidelines. LEVEL OF EVIDENCE: 3.

Mechanical Percussion Devices: A Survey of Practice Patterns Among Healthcare Professionals.

Background: Mechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice. Purpose: To survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States. Design: Cross-sectional survey study. Methods: A 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. Results: Four hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334). Conclusion: These results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines. Level of Evidence: 3.

BALANCE TRAINING: DOES ANTICIPATED BALANCE CONFIDENCE CORRELATE WITH ACTUAL BALANCE CONFIDENCE FOR DIFFERENT UNSTABLE OBJECTS?

BACKGROUND: Sports rehabilitation professionals often prescribe unstable objects for balance training. Unfortunately, there is a lack of measurement of balance confidence when incorporating these objects. Currently, there is no consensus on the optimal balance confidence measure or proposed progression of unstable objects. Understanding the influence of balance confidence on task performance using unstable objects may help professionals better prescribe a balance training program. PURPOSE: The primary purpose of this investigation was to explore the correlation between anticipated and actual balance confidence on different unstable objects during static double leg and single leg stance. The secondary purpose was to explore the correlation between anticipated and actual unstable object difficulty rankings. STUDY DESIGN: Repeated measure observational, controlled trial. METHODS: Sixty-five active, healthy adults (M = 35, F = 30) (mean age = 24.38 ± 3.56) underwent two testing sessions. During session one, participants took an online survey, rating their anticipated balance confidence after observing images of different unstable objects. During session two, participants stood on each unstable object under two conditions (static double leg stance and single leg stance) and rated their actual balance confidence. The main outcome measure was an ordinal balance confidence score adapted from the activities-specific balance confidence scale. Statistical analysis included subject demographic calculations and appropriate non-parametric tests. RESULTS: For the double leg stance and single leg stance conditions, there was a very strong correlation between anticipated and actual balance confidence scores on the stable surface (ρ = 1.0, p = <.001). There was a weak correlation between scores for foam pad, air-filled discs, Bosu® (dome up), Bosu® (dome down), and wobble board for both conditions. For unstable object rankings, there was a very strong correlation between scores (ρ=1.0, p = <.001). The objects were ranked by perceived difficulty as follows: Level 1 (easy)- ground, Level 2- foam pad, Level 3- air-filled discs, Level 4- Bosu®, and Level 5 (difficult)- wobble board. CONCLUSION: Study findings suggest that actual measures of balance confidence may provide insight into a patient's confidence level and may help with prescribing and progressing their program. The suggested unstable object difficulty rankings may help professionals better match the objects to their patients to produce optimal outcomes. LEVEL OF EVIDENCE: 2c.

Foam Rolling Prescription: A Clinical Commentary.

Behm, DG, Alizadeh, S, Hadjizadeh Anvar, S, Mahmoud, MMI, Ramsay, E, Hanlon, C, and Cheatham, S. Foam rolling prescription: a clinical commentary. J Strength Cond Res 34(11): 3301-3308, 2020-Although the foam rolling and roller massage literature generally reports acute increases in range of motion (ROM) with either trivial or small performance improvements, there is little information regarding appropriate rolling prescription. The objective of this literature review was to appraise the evidence and provide the best prescriptive recommendations for rolling to improve ROM and performance. The recommendations represent studies with the greatest magnitude effect size increases in ROM and performance. A systematic search of the rolling-related literature found in PubMed, ScienceDirect, Web of Science, and Google Scholar was conducted using related terms such as foam rolling, roller massage, ROM, flexibility, performance, and others. From the measures within articles that monitored ROM (25), strength (41), jump (41), fatigue (67), and sprint (62) variables; regression correlations and predictive quadratic equations were formulated for number of rolling sets, repetition frequency, set duration, and rolling intensity. The analysis revealed the following conclusions. To achieve the greatest ROM, the regression equations predicted rolling prescriptions involving 1-3 sets of 2-4-second repetition duration (time for a single roll in one direction over the length of a body part) with a total rolling duration of 30-120-second per set. Based on the fewer performance measures, there were generally trivial to small magnitude decreases in strength and jump measures. In addition, there was insufficient evidence to generalize on the effects of rolling on fatigue and sprint measures. In summary, relatively small volumes of rolling can improve ROM with generally trivial to small effects on strength and jump performance.

A Clinically Relevant Method of Quantifying the Mechanical Properties of RockTape® Kinesiology Tape at Different Elongation Lengths.

CONTEXT: Kinesiology tape (KT) is a therapeutic intervention used to treat different musculoskeletal conditions and to enhance sports performance. The evidence is inconclusive, with researchers attributing the variable outcomes to different manufactured KT used in the research. Researchers have begun to measure and document the mechanical properties of different brands, using machines versus professionals. This prevents a clear translation to clinical practice, as it may be difficult to reproduce outcomes. There is a need to measure the mechanical properties of KT using more clinically relevant methodology. OBJECTIVE: The purpose was to document a clinically relevant method of measuring the mechanical properties of 2 different types of precut RockTape® tape at common elongation lengths and to establish the methodology for future validation research on this testing method. DESIGN: Controlled laboratory study. SETTING: University laboratory. PARTICIPANTS: One researcher conducted all measurements. PROCEDURES: Each tape was measured at 3 elongation lengths with a force gauge. MAIN OUTCOME MEASURES: Force, stress, and Young modulus. RESULTS: The RockTape® 2 and RockTape® 3 elongation force were 25% = 2.27 (0.21) and 2.12 (0.26) N, 50% = 6.51 (0.27) and 5.93 (0.20) N, and 75% = 30.13 (0.63) and 21.23 (0.41) N. The stress values for the RockTape® 2 and RockTape® 3 were 25% = 0.88 (0.05) and 0.82 (0.03) kPa, 50% = 2.52 (0.03) and 2.29 (0.01) kPa, and 75% = 11.67 (0.04) and 8.23 (0.02) kPa. The Young modulus values for the RockTape® 2 and RockTape® 3 were 25% = 3.51 (0.00) and 3.29 (0.00) kPa, 50% = 5.04 (0.00) and 4.60 (0.00) kPa, and 75% = 15.57 (0.00) and 10.96 (0.00) kPa. CONCLUSION: This investigation documented a novel method of measuring the mechanical properties of 2 types of RockTape® KT. Future research should attempt to validate these testing methods.

AN EXPLORATORY CASE SERIES ANALYSIS OF THE USE OF PRIMAL REFLEX RELEASE TECHNIQUE™ TO IMPROVE SIGNS AND SYMPTOMS OF HAMSTRING STRAIN.

BACKGROUND/PURPOSE: Hamstring strain (HS), a common condition found among the injured physically active population, is often treated with rest, stretching, and modalities. Primal Reflex Release Technique™ (PRRT™) is a manual therapy technique used to treat pain caused by over-stimulation of the body's primal reflexes. The purpose of this case series was to explore the immediate effects of PRRT™ for treating hamstring strains. DESCRIPTION OF CASES: A multi-site case series approach was used to report on the treatment of six patients with HS using PRRT™. The Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS) and range of motion (ROM) measurements were collected, as well as evaluation of symmetry of the sacroiliac joints, reported as sacroiliac dysfunction(SJD). OUTCOMES: Primal Reflex Release Technique™ (PRRT™) was an effective treatment for subjects with HS. Subjects reported a significant decrease in pain on the NPRS, averaging five points over the course of the treatment (95% CI of 3.374, 6.626). Functional measures on the PSFS were significantly improved following treatment (post-treatment mean = 7.8 ± 1.84, pre-treatment mean = 4.8 ± .97, p < .001; CI: -2.1, -3.9). The mean change on the Passive Knee Extension Test (PKE) (mean = 8.20 ° ± 3.96 °) and ASLR (mean = 10.333 ° ± 8.98 °) indicated statistically significant improvements of post-treatment ROM (mean change = 8.20 ° ± 3.96 °, p = .01). The presence of SJD was observed in all subjects prior to treatment and resolved in all subjects when reassessed after treatment. DISCUSSION: In this case series, the use of PRRT™ resulted in decreased pain, increased function, and increased range of motion, as well as resolved SJD. The Primal Reflex Release Technique™ may be useful in decreasing symptoms of HS acutely, but long-term effects are unknown at this time. Clinicians should consider using a treatment which targets the autonomic nervous system when addressing pain associated with HS. LEVEL OF EVIDENCE: Level 4 - case series.

Roller Massage: Comparing the Immediate Post-Treatment Effects Between an Instructional Video and a Self-Preferred Program Using Two Different Density-Type Roller Balls.

The aims of this study were to (1) compare the immediate post-treatment effects of an instructional video versus a self-preferred program on the hip range of motion and a pressure pain threshold using two different density roller balls, and (2) compare the effects of the two roller balls on those variables. Forty adults were randomly allocated into four groups: (1) MB1-video, (2) MB1-self-preferred, (3) MBX-video, and (4) MBX-self-preferred. Participants followed a video or a self-preferred program using either a moderate (MB1) or a hard (MBX) density ball. Main outcomes were passive hip internal rotation, external rotation, and a pressure pain threshold. For MB1, the video produced greater outcomes than the self-program for external rotation (10◦ versus 2◦), internal rotation (7◦ versus 2◦), and the pain threshold (210 kPa versus 44 kPa). For MBX, the video produced greater outcomes than the self-program for external rotation (8◦ versus 1◦), internal rotation (5◦ versus 1◦), and the pain threshold (184 kPa versus 30 kPa). When comparing roller balls, the MB1 produced greater outcomes than the MBX for external rotation (10◦ versus 8◦), internal rotation (7◦ versus 5◦), and the pain threshold (210 kPa versus 184 kPa) with the video. For the self-preferred program, the MB1 produced greater outcomes for external rotation (2◦ versus 1◦), internal rotation (2◦ versus 1◦), and the pain threshold (44 kPa versus 30 kPa). The instructional video and a moderate density ball produced greater immediate post-treatment outcomes than the self-program and a hard density ball. Professionals should consider using the video to teach technique and match clients to a specific density-type roller ball.

Examining the factorial validity of the Quality of Life Scale.

BACKGROUND: Quality of life (QoL) is important to assess in patient care. Researchers have previously claimed validity of the Quality of Life Scale (QOLS) across multiple samples of individuals, but close inspection of results suggest further psychometric investigation of the instrument is warranted. Therefore, the purposes of this study were to: 1) evaluate the proposed five-factor, 15-item and three-factor, 16-item QOLS; 2) if the factor structure could not be confirmed, re-assess the QOLS using exploratory factor analysis (EFA) and covariance modeling to identify a parsimonious refinement of the QOLS structure for future investigation. METHODS: Participants varying in age, physical activity level, and identified medical condition(s) were recruited from clinical sites and ResearchMatch. Confirmatory factor analyses (CFA) were performed on the full sample (n = 1036) based on proposed 15- and 16-item QOLS versions. Subsequent EFA and covariance modeling was performed on a random subset of the data (n1 = 518) to identify a more parsimonious version of the QOLS. The psychometric properties of the newly proposed model were confirmed in the remaining half of participants (n2 = 518). Further examination of the scale psychometric properties was completed using invariance testing procedures across sex and health status sub-categories. RESULTS: Neither the 15- nor 16-item QOLS CFA met model fit recommendations. Subsequent EFA and covariance modeling analyses revealed a one-factor, five-item scale that satisfied contemporary statistical and model fit standards. Follow-up CFA confirmed the revised model structure; however, invariance testing requirements across sex and injury status subgroups were not met. CONCLUSIONS: Neither the 15- nor 16-item QOLS exhibited psychometric attributes that support construct validity. Our analyses indicate a new, short-form model, might offer a more appropriate and parsimonious scale from some of the original QOLS items; however, invariance testing across sex and injury status suggested the psychometric properties still vary between sub-groups. Given the scale design concerns and the results of this study, developing a new instrument, or identifying a different, better validated instrument to assess QoL in research and practice is recommended.