The Relationship between Pain Catastrophizing and Cognitive Function in Chronic Musculoskeletal Pain: A Scoping Review.

Objective: Chronic musculoskeletal pain (CMP) poses a considerable threat to physical, mental, and financial health worldwide. Beyond physical difficulties, CMP has a pronounced impact on pain behaviors and cognitive function. The purpose of this scoping review was to examine the relationship between pain catastrophizing (PC) and cognitive function in CMP, identify gaps in the literature, and provide future directions for research on the topic. Methods: Search strings were entered in the following databases: PubMed, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, and Scopus. Data from the included articles were extracted thematically based on diagnostic classification and included author(s), year of publication, country, aim, sample, methods, intervention (if applicable), and key findings. Results: 30 articles were included after screening. The studied populations included patients with fibromyalgia, chronic low back pain, and CMP. Two studies were designed to assess the relationship between PC and cognition as the primary aim. The included studies demonstrated variable evidence regarding the relationship between PC and cognition. Only four studies included clinically relevant PC populations (i.e., Pain Catastrophizing Scale score >30), and all found significant correlations. Conclusion: Although evidence exists for the relationship between cognitive function and PC, there is a lack of rigorous research to indicate the strength of this relationship and the specific cognitive functions affected. The literature lacks appropriate populations needed to investigate clinically relevant PC and is limited by heterogeneous neuropsychological test batteries. Future research should include populations demonstrating the behaviors being studied, intentional analysis of outcomes, and appropriate cognitive tests.

Effectiveness of Spinal Stabilization Exercises on Dynamic Balance in Adults with Chronic Low Back Pain.

Background: Dynamic balance is a vital aspect of everyday life. It is important to incorporate an exercise program that is useful for maintaining and improving balance in patients with chronic low back pain (CLBP). However, there is a lack of evidence supporting the effectiveness of spinal stabilization exercises (SSEs) on improving dynamic balance. Purpose: To determine the effectiveness of SSEs on dynamic balance in adults with CLBP. Study Design: A double-blind randomized clinical trial. Methods: Forty participants with CLBP were assigned randomly into either an SSE group or a general exercise (GE) group, which consisted of flexibility and range-of-motion exercises. Participants attended a total of four to eight supervised physical therapy (PT) sessions and performed their assigned exercises at home in the first four weeks of the eight-week intervention. In the last four weeks, the participants performed their exercises at home with no supervised PT sessions. Participants' dynamic balance was measured using the Y-Balance Test (YBT) and the normalized composite scores, Numeric Pain Rating Scale and Modified Oswestry Low Back Pain Disability Questionnaire scores were collected at baseline, two weeks, four weeks, and eight weeks. Results: A significant difference between groups from two weeks to four weeks (p = 0.002) was found, with the SSE group demonstrating higher YBT composite scores than the GE group. However, there were no significant between-group differences from baseline to two weeks (p =0.098), and from four weeks to eight weeks (p = 0.413). Conclusions: Supervised SSEs were superior to GEs in improving dynamic balance for the first four weeks after initiating intervention in adults with CLBP. However, GEs appeared to have an effect equivalent to that of SSEs after 8-week intervention. Levels of Evidence: 1b.

Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain.

Introduction: Low back pain (LBP) is a musculoskeletal disorder that affects more than 80% of people in the United States at least once in their lifetime. LBP is one of the most common complaints prompting individuals to seek medical care. The purpose of this study was to determine the effects of spinal stabilization exercises (SSEs) on movement performance, pain intensity, and disability level in adults with chronic low back pain (CLBP). Methods: Forty participants, 20 in each group, with CLBP were recruited and randomly allocated into one of two interventions: SSEs and general exercises (GEs). All participants received their assigned intervention under supervision one to two times per week for the first four weeks and then were asked to continue their program at home for another four weeks. Outcome measures were collected at baseline, two weeks, four weeks, and eight weeks, including the Functional Movement ScreenTM (FMSTM), Numeric Pain Rating Scale (NPRS), and Modified Oswestry Low Back Pain Disability Questionnaire (OSW) scores. Results: There was a significant interaction for the FMSTM scores (p = 0.016), but not for the NPRS and OSW scores. Post hoc analysis showed significant between-group differences between baseline and four weeks (p = 0.005) and between baseline and eight weeks (p = 0.026) favor SSEs over GEs. Further, the results demonstrated that all participants, regardless of group, had significant improvements in movement performance, pain intensity, and disability level over time. Conclusion: The results of the study favor SSEs over GEs in improving movement performance for individuals with CLBP, specifically after four weeks of the supervised SSE program.

Lack of standardization in dry needling dosage and adverse event documentation limits outcome and safety reports: a scoping review of randomized clinical trials.

OBJECTIVES: Examine: (1) whether variability in dry needling (DN) dosage affects pain outcomes, (2) if effect sizes are clinically important, and (3) how adverse events (AE) were documented and whether DN safety was determined. METHODS: Nine databases were searched for randomized controlled trials (RCTs) investigating DN in symptomatic musculoskeletal disorders. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Included RCTs met PEDro criteria #1 and scored > 7/10. Data extraction included DN dosage, pain outcome measures, dichotomous AE reporting (yes/no), and AE categorization. Clinically meaningful differences were determined using the minimum clinically important difference (MCID) for pain outcomes . RESULTS: Out of 22 identified RCTs, 11 demonstrated significant between-group differences exceeding the MCID, suggesting a clinically meaningful change in pain outcomes. Nine documented whether AE occurred. Only five provided AEs details and four cited a standard means to report AE. DISCUSSION: There was inconsistency in reporting DN dosing parameters and AE. We could not determine if DN dosing affects outcomes, whether DN consistently produces clinically meaningful changes, or establish optimal dosage. Without more detailed reporting, replication of methods in future investigations is severely limited. A standardized method is lacking to report, classify, and provide context to AE from DN. Without more detailed AE reporting in clinical trials investigating DN efficacy, a more thorough appraisal of relative risk, severity, and frequency was not possible. Based on these inconsistencies, adopting a standardized checklist for reporting DN dosage and AE may improve internal and external validity and the generalizability of results.

Women with Chronic Pelvic Pain Demonstrate Increased Lumbopelvic Muscle Stiffness Compared to Asymptomatic Controls.

Background: Although lumbopelvic muscle stiffness is commonly clinically assessed in women with chronic pelvic pain (CPP), it has not been objectively quantified in this population, and its association with other pain-related impairments has not yet been established. Objective: To compare superficial lumbopelvic muscle stiffness in women with and without CPP. In addition, pressure pain threshold (PPT) was compared between groups and the associations between muscle stiffness and PPT were assessed in women with CPP. Study Design: Case-control. Methods: Muscle stiffness and PPT of 11 lumbopelvic muscles were assessed in 149 women with CPP and 48 asymptomatic women. Subjective outcome measures, including pelvic floor function, health history, and psychosocial outcomes, were collected before muscle stiffness and PPT measurements. Analysis of covariance was used to compare muscle stiffness differences between groups, and independent t-tests were used to compare PPT between groups. Associations between measurements of PPT and muscle stiffness were calculated using correlation analysis. Results: Five of the 11 muscles measured were significantly stiffer in women with CPP than those without CPP (p < 0.05). PPT was significantly decreased in all muscles measured in women with CPP; however, there was not a significant association between muscle stiffness and PPT in women with CPP. Conclusion: The study identified the abdominal lumbopelvic muscles that have increased stiffness in women with CPP compared to asymptomatic women. In addition, muscle stiffness and PPT are two distinct impairments within this population. The results suggest that women with CPP have peripheral muscle impairments, which may be addressed without intravaginal or intrarectal intervention. Clinical Trial Registration: NCT04851730.

Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions.

Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.

Energy Absorption Contribution Deficits in Participants Following Anterior Cruciate Ligament Reconstruction: Implications for Second Anterior Cruciate Ligament Injury.

CONTEXT: Lower-extremity loading patterns change after anterior cruciate ligament reconstruction (ACLR). However, there is limited research regarding energy absorption contribution (EAC) of athletes following ACLR who reinjure their ACL and those who do not. EAC can be utilized as a measure of joint loading during tasks. DESIGN: Cross-sectional study. METHODS: Three groups of individuals (13 in each group) with matched age, sex, height, weight, and sports were enrolled. Data were collected at time of return-to-sport testing for the 2 ACLR groups. An 8-camera 3D motion capture system with a sampling rate of 120 Hz and 2 force plates capturing at 1200 Hz were used to capture joint motions in all 3 planes during a double-limb jump landing. RESULTS: Participants in the ACLR no reinjury and ACLR reinjury groups had significantly greater hip EAC (55.8 [21.5] and 56.7 [21.2]) compared with healthy controls (19.5 [11.1]), P < .001 and P < .001, respectively. The ACLR no reinjury and ACLR reinjury groups had significantly lower knee EAC (24.6 [22.7] and 27.4 [20.8]) compared with healthy controls (57.0 [12.2]), P < .001 and P < .001, respectively. However, the ACLR reinjury group had significantly lower ankle EAC (15.9 [4.6]) than healthy controls (23.5 [6.6]), whereas there was no statistical difference between the ACLR no reinjury group (19.7 [7.8]) and healthy controls. CONCLUSIONS: Athletes who had a second ACL injury after ACLR, and those without second ACL injury, appear to have similar hip, knee, and ankle joint loading of the surgical limb at return-to-sport testing. Nevertheless, joint loading patterns were significantly different from healthy controls. The study suggests that EAC as a measure of joint loading during a double-limb jump landing at time of return to sport may not be a strong predictor for second injury following ACLR.

Validity and reliability of dry needle placement in the deep lumbar multifidus muscle using ultrasound imaging: an in-vivo study.

OBJECTIVES: To use ultrasound (US) imaging to determine the validity and reliability of needle placement of two dry needling (DN) protocols for the lumbar multifidus (LM) in individuals with a high body mass index (BMI). METHODS: Twenty-one participants with a BMI higher than 25 kg/m2 completed the study. A US scanner was used to determine the location of needle placement after a 100 mm long needle was inserted in the LM at L4 and L5 following two DN protocols for the deep LM muscle. US images were saved and viewed 6 months later to determine the intra-tester reliability. RESULTS: The probability of reaching the deep LM muscle was high (85-95%) at L4 and L5. Although the needle reached a bony landmark 85-100% of the time, it only reached the vertebra lamina as intended 70-75% of the time. The intra-tester reliability of needle placements based on analysis of real-time and recorded US images was poor-to-moderate. CONCLUSIONS: Although the bony drop may not indicate that the needle has reached the vertebra lamina as the protocol intended, reaching a bony drop is still meaningful as it coincided with reaching the LM in the majority of participants.

Using quantitative sensory testing to predict attrition in an interdisciplinary pain management program: a pilot study.

Aim: To determine the extent to which quantitative sensory testing (QST) predicted attrition in an interdisciplinary pain program (IPP). Patients & methods: Participants (n = 53) enrolled in an IPP completed pretreatment assessments of QST and the PROMIS-29 quality of life survey. Results & conclusion: Compared with completers, non-completers (24.5%) reported significantly higher pain intensity (7.1, 95% CI [5.8, 8.4] versus 5.4, 95% CI [4.8, 6.1]) and cold hyperalgesia (14.6°C, 95% CI [8.8, 20.4] versus 7.5°C, 95% CI [4.8, 6.1]), with both variables also predicting attrition. This finding highlights a potentially novel and clinically significant use of QST. Higher overall pain intensity and the presence of remote cold hyperalgesia may identify patients at risk for dropping out of an IPP.

The purpose of this research study was to determine the extent to which quantitative sensory testing (QST) predicted which patients enrolled in an interdisciplinary pain program (IPP) would drop out. Fifty-three patients with chronic pain enrolled in an IPP were assessed before treatment with mechanical and thermal QST at a painful and a non-painful site, as well as with the PROMIS-29 quality of life survey. Pretreatment findings were compared between non-completers (i.e., attended five or fewer sessions for any component of the IPP) and completers. Resulting significant predictors were included in a logistic regression to predict attrition. Compared with those who completed the program, non-completers (24.5%) reported significantly higher pain intensity and oversensitivity to cold at a non-painful site pretreatment, with both variables also predicting completion of the IPP. In summary, these preliminary findings suggest that higher overall pain intensity and the presence of cold oversensitivity (at baseline) may identify patients at risk for dropping out of an IPP.

Limb Dominance Does Not Affect Y-Balance Test Performance in Non-Athlete Adolescents.

BACKGROUND: The Lower Quarter Y-Balance Test (YBT-LQ) has been shown to be reliable for assessing dynamic balance in children and adolescents. However, limited research is available about the effects of leg dominance on YBT-LQ performance in adolescents. In addition, there is no consensus on the use of maximum reach or mean reach distance being a better measure of YBT-LQ performance. HYPOTHESIS/PURPOSE: The purposes of this study were to determine if there is a difference in the YBT-LQ performance between the dominant and non-dominant limbs in non-athlete adolescents, and to compare the reliability of the maximum reach scores to that of the mean reach scores in this population. STUDY DESIGN: Prospective cohort study. METHODS: Twenty-six healthy non-athlete adolescents (13.6 ± 1.0 years, 22 girls, 4 boys) performed the YBT-LQ on two separate days while the same investigator scored their performance. Paired t-tests were used to compare reach distances on dominant and non-dominate stance limbs. Intraclass correlation coefficients (ICC3,1) were calculated for the maximum and mean reach distances for three directions (anterior, posterolateral, posteromedial) and the composite scores on each limb. RESULTS: There was no significant difference in YBT-LQ performance between dominant and non-dominant stance limbs (p > 0.05). Overall, the between-day intra-rater reliability for maximum reach and mean reach scores was moderate-to-good for both limbs (ICC3,1 = 0.59 - 0.83), but was poor for the composite score on the dominant limb (ICC3,1 = 0.42) and maximum anterior reach on non-dominant limb (ICC3,1 = 0.48). CONCLUSION: Limb dominance does not seem to be a factor for YBT-LQ performance in this population. The YBT-LQ appears to be a reliable tool for dynamic balance assessment in non-athlete adolescents using the individual score of each direction. The use of mean reach measures seems to slightly improve reliability, specifically the anterior reach direction, in this population. LEVEL OF EVIDENCE: Level 2b.

Normalized Hip and Knee Strength in Two Age Groups of Adolescent Female Soccer Players.

ABSTRACT: Hannon, JP, Wang-Price, S, Garrison, JC, Goto, S, Bothwell, JM, and Bush, CA. Normalized hip and knee strength in two age groups of adolescent female soccer players. J Strength Cond Res 36(1): 207-211, 2022-Limb symmetry strength measures are used for clinical decision-making considering when an athlete is ready to return to sport after anterior cruciate ligament (ACL) injuries. However, changes in bilateral muscle strength occur after ACL injury resulting in potentially altered limb symmetry calculations. Adolescent female soccer players are at increased risk of sustaining ACL injuries. Published age and sex-matched strength values in this population may be of benefit to clinicians to improve clinical decision-making. The purpose of this study was to establish normative hip and knee strength data of both the dominant and nondominant limbs in adolescent female soccer players. Sixty-four female soccer players (ages 10-18) were enrolled in this study. Subjects were divided by age into 2 groups (group 1: 10-14 years; group 2: 15-18 years). Subjects underwent Biodex isokinetic strength testing at 60°·s-1 and 180°·s-1 to assess quadriceps and hamstring strength. Isometric hip strength (abduction and external rotation) was measured using a hand-held dynamometer. No significant differences were found between groups on either limb in regards to quadriceps or hamstring strength. No significant differences were found between groups on either limb for hip external rotation strength. Significant differences in hip abduction strength were found between groups on the dominant (group 1: 0.21 ± 0.04; group 2: 0.18 ± 0.04; p = 0.014) and nondominant (group 1: 0.21 ± 0.05; group 2: 0.18 ± 0.05; p = 0.019) limbs. The results of this study shed light on normative strength values for a high-risk injury population.

Segmental spine mobility differences between lumbar flexion- and extension-based movement syndromes in patients with low back pain.

BACKGROUND: The Movement System Impairment (MSI) model is useful for identifying spine-hip mobility and motor control deficits that may contribute to low back pain (LBP). While previous studies have found differences in global spine-hip movement impairments between lumbar MSI subgroups, no studies have compared segmental spine movement impairments between these subgroups. Therefore, the purpose of this study is to analyze segmental lumbar mobility in participants with LBP and a lumbar flexion- or extension-based MSI. METHODS: Forty participants with subacute-chronic LBP were placed into one of three age groups (< 35, 35-54, or > 54 years-old) and then classified into a flexion- or extension-based MSI sub-group. Segmental lumbar range of motion (ROM) was measured in degrees using a skin-surface device. Total lumbar and segmental flexion and extension ROM of L1-L2 to L5-S1 was compared between MSI sub-groups for each age group using separate two-way ANOVAs. RESULTS: Significant main effects were found for the independent variables of MSI subgroup and age. Participants in all three age groups with a flexion-based MSI displayed significantly less lumbar extension (-0.6∘) at L4-5 as compared to participants with an extension-based MSI (-2.1∘), p= 0.03. In addition, lumbar total and segmental ROM was significantly less for older individuals in both subgroups. CONCLUSIONS: Individuals with LBP may demonstrate a pattern of lumbar segmental hypomobility in the opposite direction of their MSI. Future studies may investigate the added value of direction-specific spinal mobilization to a program of MSI-based exercise.

Walking with and without a robotic exoskeleton in people with incomplete spinal cord injury compared to a typical gait pattern.

BACKGROUND: Robotic exoskeleton (RE) enables individuals with lower extremity weakness or paralysis to stand and walk in a stereotypical pattern. OBJECTIVE: Examine whether people with chronic incomplete spinal cord injury (SCI) demonstrate a more typical gait pattern when walking overground in a RE than when walking without. METHODS: Motion analysis system synchronized with a surface electromyographic (EMG) was used to obtain temporospatial gait parameters, lower extremity kinematics, and muscle activity in ambulatory individuals with SCI and healthy adults. RESULTS: Temporospatial parameters and kinematics for participants with SCI (n = 12; age 41.4±12.5 years) with and without RE were significantly different than a typical gait (healthy adults: n = 15; age 26.2±8.3 years). EMG amplitudes during the stance phase of a typical gait were similar to those with SCI with and without RE, except the right rectus femoris (p = 0.005) and left gluteus medius (p = 0.014) when participants with SCI walked with RE. EMG amplitudes of participants with SCI during the swing phase were significantly greater compared to those of a typical gait, except for left medial hamstring with (p = 0.025) and without (p = 0.196) RE. CONCLUSIONS: First-time walking in a RE does not appear to produce a typical gait pattern in people with incomplete SCI.

Reliability and Validity of the Y-balance Test in Young Adults with Chronic Low Back Pain.

BACKGROUND: Individuals with chronic low back pain (CLBP) may demonstrate reduced ability to perform dynamic tasks due to fear of additional pain and injury in response to the movement. The Y-balance test (YBT) is a functional and inexpensive test used with various populations. However, the reliability and validity of the YBT used for assessing dynamic balance in young adults with CLBP have not yet been examined. PURPOSE: To determine the inter-rater reliability of the YBT and to compare dynamic balance between young adults with CLBP and an asymptomatic group. STUDY DESIGN: Reliability and validity study. METHODS: Fifteen individuals with CLBP (≥ 12 weeks) and 15 age- and gender-matched asymptomatic adults completed the study. Each group consisted of 6 males and 9 females who were 21-38 years of age (27.47 ± 5.0 years). The YBT was used to measure participant's dynamic balance in the anterior (ANT), posteromedial (PM) and posterolateral (PL) reach directions. The scores for each participant were independently determined and recorded to the nearest centimeter by two raters. Both the YBT reach distances and composite scores were collected from the dominant leg of asymptomatic individuals and the involved side of participants with CLBP and were used for statistical analysis. RESULTS: The YBT demonstrated excellent inter-rater reliability, with intraclass correlation coefficients ranging from 0.99 to 1.0 for the YBT scores of both asymptomatic and CLBP groups. The CLBP group had lower scores than those of the asymptomatic group in the reach distances of the ANT (p = 0.023), PM (p < 0.001), and PL (p = 0.001) directions, and the composite scores (p < 0.001). CONCLUSIONS: The results demonstrated excellent inter-rater reliability and validity of the YBT for assessing dynamic balance in the CLBP population. The YBT may be a useful tool for clinicians to assess dynamic balance deficits in patients with CLBP. LEVEL OF EVIDENCE: 2b.

Twelve-Week Quadriceps Strength as A Predictor of Quadriceps Strength At Time Of Return To Sport Testing Following Bone-Patellar Tendon-Bone Autograft Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Restoration of quadriceps strength following anterior cruciate ligament reconstruction (ACL-R) continues to challenge both patients and clinicians. Failure to adequately restore quadriceps strength has been linked to decreased patients' self-reported outcomes and an increased risk for re-injury. Early identification of quadriceps strength deficits may assist in tailoring early interventions to better address impairments. PURPOSE: The purpose of this study was to assess the relationship between early (12 weeks following ACL-R) isokinetic peak torque and isokinetic peak torque at time of return to sport (RTS) testing. STUDY DESIGN: Cohort Study. METHODS: A total of 120 participants (males = 55; females =65) were enrolled in the study (age = 16.1±1.4 yrs; height = 1.72±10.5 m; mass = 70.7±16.3 kg). All participants were level 1 or 2 cutting and pivoting sport athletes who underwent a primary bone-patellar tendon-bone autograft ACL-R. Participants were tested at two time points: 12 weeks following surgery and again at time of RTS testing. A linear regression model was carried out to investigate the relationship between age, sex, and isokinetic peak torque at 12 weeks following ACL-R and isokinetic peak torque at time of RTS testing. RESULTS: When 12-week isokinetic peak torque was entered first for the hierarchy regression analysis, this factor was predictive of the peak torque at the time of RTS testing, F(1, 118) = 105.6, p < 0.001, R 2 = 0.472, indicating that the 12-week quadriceps strength accounted for 47% of the variance in the quadriceps strength at the time of RTS testing. When age and sex were added in the regression analysis, both factors only added 0.8% of variance for the quadriceps strength at the time of RTS testing. CONCLUSION: Isokinetic peak torque at 12 weeks following surgery was shown to be a significantly strong predictor (47%) for isokinetic quadriceps strength recovery at time of RTS. This finding underscores the importance of early restoration of quadriceps strength and that while non-modifiable factors such as sex and age are important, early restoration of quadriceps strength most strongly influences late stage quadriceps strength. LEVEL OF EVIDENCE: 3.

Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain.

Background: Low back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system. Purpose: The purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system. Study Design: Reliability and validity study. Methods: Twenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant's FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability. Results: The results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008). Conclusions: The results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP. Levels of Evidence: 2b.

Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study.

BACKGROUND: The Central Sensitization Inventory (CSI) is often used in clinical settings to screen for the presence of central sensitization. However, various cutoff scores have been reported for this tool, and scores have not been consistently associated with widespread pain sensitivity as measured with quantitative sensory testing (QST). The purpose of this study was to compare QST profiles among asymptomatic controls and participants with chronic musculoskeletal pain (CMP), and to determine the association between self-report questionnaires and QST in participants with CMP. METHODS: Twenty asymptomatic controls and 46 participants with CMP completed the CSI, PROMIS-29, and QST assessments of mechanical and thermal pain thresholds remote to the area of pain. Receiver Operating Characteristic analysis revealed a cutoff score of 33.5 for the CSI. PROMIS-29 Quality of Life (QOL) inventory and QST measures were compared between low and high CSI groups. RESULTS: The high CSI group (n = 19) had significantly lower mechanical and thermal pain thresholds, and larger impairments in QOL measures, compared to the low CSI group (n = 27) and asymptomatic controls. Participants with CSI scores < 33.5 presented similarly to asymptomatic controls. Anxiety, pain interference, and CSI scores demonstrated the highest number of significant associations to QST measures. CONCLUSION: A cutoff score of 33.5 on the CSI may be useful for discriminating widespread pain sensitivity and quality of life impairments in participants with CMP. Future studies should consider how the presence of high or low CSI may impact differential diagnosis, prognosis, and treatment responsiveness for patients with primary or secondary CMP.

Quadriceps strength changes across the continuum of care in adolescent male and female athletes with anterior cruciate ligament injury and reconstruction.

OBJECTIVES: To examine the quadriceps strength (QUADS) on the surgical (SURG) and non-surgical (Non-SURG) limbs in adolescent male and female athletes at pre-operative (PRE), 12 weeks post-operative (12WK), and return to sport (RTS) time points following ACL injury and reconstruction. DESIGN: Prospective cohort study design. SETTING: Clinical Research Laboratory. PARTICIPANTS: 66 adolescent athletes. MAIN OUTCOME MEASURES: Isokinetic QUADS of the SURG and Non-SURG limbs at the PRE, 12WK, and RTS time points were assessed and compared between each time point. RESULTS: Both male and female participants had significantly lower 12 WK QUADS in the SURG limb than the PRE QUADS, but the RTS QUADS was significantly greater than the 12WK QUAD (p < 0.05). However, only female participants had greater RTS QUADS as compared to the PRE QUADS (p < 0.001). For the Non-SURG limb, only male participants had a significant improvement over time (PRE vs RTS; p < 0.001). CONCLUSION: Adolescent males and females differ in their QUADS recovery across the continuum of care following ACLR. Clinicians should consider this pattern of recovery when treating adolescent males and females.

A Comparison of Clinical Outcomes between Early Cervical Spine Stabilizer Training and Usual Care in Individuals following Anterior Cervical Discectomy and Fusion.

OBJECTIVES: Early physical therapy (PT) with specific stabilization training has been shown to benefit individuals after lumbar spinal surgery but has not been studied in patients after cervical spine surgery. The primary purpose of this study was to compare clinical outcomes between early cervical spine stabilizer (ECS) training and usual care (UC) in patients after anterior cervical discectomy and fusion (ACDF) surgery. The secondary purpose was to determine test-retest reliability of strength and endurance tests of cervical spinal stabilizers in this patient population. METHODS: Forty participants who were scheduled for ACDF surgery were randomized into either the ECS group or the UC group. After surgery, participants received their assigned group intervention during their hospital stay and continued their assigned intervention for 12 weeks. All participants had phone follow-ups twice during the first 6 weeks to address questions or problems. Clinical outcome measures including pain level using the Numeric Pain Rating Scale (NPRS), disability level using the Neck Disability Index (NDI), Craniocervical Flexor Strength (CCF-S), and Craniocervical Flexor Endurance (CCF-E) were collected three times: before surgery and 6 and 12 weeks after surgery. Test-retest reliability was assessed in the first 10 participants. RESULTS: There was no significant interaction between the groups over time for any of the outcome measures. However, all participants made significant improvements in all four outcome measures at 6 and 12 weeks post surgery. The results showed good-to-excellent test-retest reliability for the CCF-S and CCF-E tests. CONCLUSIONS: Both ECS training and UC resulted in the same amount of improvement at 6 and 12 weeks; therefore, both therapy approaches appear to have similar and positive effects on patients in their first 3 months of recovery after ACDF. Both the CCF-S and CCF-E tests can be used reliably to assess the strength and endurance of the cervical spinal stabilizers for patients after ACDF surgery. The study was registered with the ClinicalTrials.gov (NIH, U.S. National Library of Medicine, identifier # NCT01519115) Protocol Registration system.

Effect of Meniscal Repair on Joint Loading in Athletes With Anterior Cruciate Ligament Reconstruction at 3 Months Following Surgery.

CONTEXT: Joint loading following anterior cruciate ligament reconstruction (ACL-R) is thought to influence long-term outcomes. However, our understanding of the role of meniscus repair at the time of ACL-R on early joint loading is limited. OBJECTIVE: To assess if differences in total energy absorption and energy absorption contribution of the hip, knee, and ankle exist in the early stages of rehabilitation between patients who received an isolated ACL-R and those with concomitant meniscal repairs. DESIGN: Cross-sectional. SETTING: Clinical laboratory. PATIENTS: Fifty-nine human subjects, including 27 who underwent ACL-R and 32 who underwent ACL-R with concomitant meniscal repairs. MAIN OUTCOME MEASURE: The total energy absorption and the energy absorption contribution of each joint of both the involved and uninvolved limbs during a double-limb squat task. RESULTS: There were significant differences in energy absorption contribution between groups at the knee joint (P = .01) and the hip joint (P = .04), but not at the ankle joint (P = .48) of the involved limb. Post hoc analysis indicates that preoperative hip and knee loading differences exist and when you control for preoperative loading (analysis of covariance), the postsurgery difference was not significant. CONCLUSIONS: The results of the study suggest that the additional surgical procedure of MR may not have had negative effects on joint loading during squatting at 12 weeks.