Periscapular Strength Profile Changes in Collegiate Baseball Pitchers Over the Course of a Season.

Background: Repetitive application of high forces to the shoulder and scapular musculature during the pitching motion over the course of a collegiate baseball season may lead to changes in strength and increased fatigue, potentially predisposing pitching athletes to injury. The purpose of this study was to investigate periscapular strength profiles of Division I collegiate baseball players over the course of a season. Methods: This study was a retrospective data analysis of 18 Division I baseball pitchers. Isometric scapular plane abduction (scaption), external rotator, internal rotator, middle trapezius, and lower trapezius isometric strength was measured on throwing arm of each subject using a MicroFET 2 handheld dynamometer. Data were collected in a single session at the preseason, midseason, and postseason of the college baseball season, which spanned a five-month period. A repeated measures ANOVA was utilized to determine if there was a significant change in periscapular strength across the baseball season. Results: Over the three time-points, all strength values decreased for each muscle group, with decreases ranging from 3-14%. Changes in scaption strength values were statistically significant (p=0.018, partial eta squared =0.284) with an 8% reduction over the entire season, specifically with a 5% decline from mid-season to post-season. While external rotator, internal rotator, middle trapezius, and lower trapezius strength values all decreased over the course of the season (range 0.02kg to 1.8kg), these differences were not statistically significant. However, the middle trapezius strength value change (1.3kg loss) exceeded the minimal detectible change. Conclusion: Periscapular muscles in baseball pitchers diminish in strength over the course of a collegiate baseball season. Understanding strength changes over the course of a season may influence training and therapeutic interventions. Level of Evidence: 3b.

Socioeconomic Influence on Physical Therapist Student Financial Literacy, Self-Efficacy, Stress, and Anxiety.

INTRODUCTION: Doctor of Physical Therapy (DPT) students have considerable educational debt upon graduation with suspected low levels of financial literacy, limited financial self-efficacy, and elevated stress and anxiety. The purpose of this study was to determine the relationships between financial knowledge, financial anxiety, financial stress, and financial self-efficacy with socioeconomic determinants in DPT students. SUBJECTS: Five hundred seventy-eight DPT students, surveyed through a cross-sectional sample of convenience. METHODS: Participants responded to a 40-item demographic questionnaire providing a self-assessment of their current financial literacy, financial self-efficacy, financial anxiety, financial stress, and level of general social support. Pairwise correlations were used to determine the relationship between independent variables and composite scores on self-assessment tools. Multiple regression analyses were conducted to predict financial knowledge, self-efficacy, anxiety, stress, and social support by socioeconomic indicators and educational debt status. RESULTS: While there was a moderate, positive association between presence of debt and financial self-efficacy and financial anxiety for all students (r = .55), there was no statistically significant difference in financial knowledge, self-efficacy, anxiety, stress, or social support for students based on race/ethnicity. There was a negligible to weak correlation between financial knowledge, financial self-efficacy, and level of financial anxiety based on age, race/ethnicity, gender, socioeconomic background, debt load, risk tolerance, and retirement reflection. When subjected to multiple regression analysis, the level of education-related debt could explain a large proportion of the variance in multiple measures, including financial self-efficacy, anxiety, and stress. Economic background explained a large proportion of variance in the general social support students felt. DISCUSSION AND CONCLUSION: We found a strong, positive correlation between the presence of debt and financial stress and anxiety for all DPT student respondents. While there is no difference in financial literacy and self-efficacy based on race and ethnic background, there is a moderate correlation between self-efficacy and financial anxiety for all students. Education on strategies to manage debt load may reduce both factors.

The Relationship Between Interprofessional Collaborative Practice Experience and Interprofessional Attitudes in Students from Health Professions.

Interprofessional collaborative practice (IPCP) can be achieved through purposeful interprofessional education of healthcare students within a clinical environment. The purpose of this study was to examine the relationship between past participation of students in IPCP with interprofessional attitudes of students, as measured by the Interprofessional Attitudes Scale (IPAS). It further examined differences in IPAS based on profession. A Pearson correlation examined association of IPCP experience with IPAS scores. An analysis of covariance evaluated group differences, with post-hoc tests examining pairwise differences. Participants (n=170) consisted of students from medicine, physical therapy, social work, nursing, and pharmacy. A positive relationship existed for IPAS scores and IPCP experiences for medical students and pharmacy students, but no other profession. Medical students scored lower on interprofessional attitudes when compared with other professions. Further, when controlling for IPCP experience, IPAS scores differed between medical students and all other professions for total score as well as the teamwork, roles and responsibilities subdomain. Results indicate that the volume of IPCP experience may have a relationship with interprofessional attitudes among health professional students. Evidence supports the need for continued strategic curricular design to cultivate interprofessional behaviors in students through implementation of greater amounts of IPCP experiences for students.

The Legal Foundation of Student Dismissal in Professional Education Programs.

Professional education programs are bound to ensuring that their graduates meet both academic and professional standards of performance. These standards are often set through disciplinary expectations, professional associations, accrediting bodies, and/or licensure. Due to the association of post-graduate sanctions of licensed providers with professional conduct issues at the pre-licensure or pre-graduate level, academic programs should be concerned with modeling, monitoring, and assessing these standards of their students. However, literature suggests that professional programs are not always acting on their concerns of student performance in these domains due to concern of legal action. Therefore, the purpose of this commentary is to offer a synopsis of the legal foundations and guiding principles that support the decision-making of professional education programs and its faculty. With proper structure and guidance though interpretation of existing case law, professional education programs are best positioned to not only evaluate cognitive ability, but also non-cognitive behaviors and professional expectations of students in their professional education programs.

The Application of Creatine Supplementation in Medical Rehabilitation.

Numerous health conditions affecting the musculoskeletal, cardiopulmonary, and nervous systems can result in physical dysfunction, impaired performance, muscle weakness, and disuse-induced atrophy. Due to its well-documented anabolic potential, creatine monohydrate has been investigated as a supplemental agent to mitigate the loss of muscle mass and function in a variety of acute and chronic conditions. A review of the literature was conducted to assess the current state of knowledge regarding the effects of creatine supplementation on rehabilitation from immobilization and injury, neurodegenerative diseases, cardiopulmonary disease, and other muscular disorders. Several of the findings are encouraging, showcasing creatine's potential efficacy as a supplemental agent via preservation of muscle mass, strength, and physical function; however, the results are not consistent. For multiple diseases, only a few creatine studies with small sample sizes have been published, making it difficult to draw definitive conclusions. Rationale for discordant findings is further complicated by differences in disease pathologies, intervention protocols, creatine dosing and duration, and patient population. While creatine supplementation demonstrates promise as a therapeutic aid, more research is needed to fill gaps in knowledge within medical rehabilitation.

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial.

OBJECTIVES: To determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM. METHODS: Sixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups. RESULTS: The MANOVA found significant ROM differences between the three intervention groups (F6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods. CONCLUSION: A single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.

Utilization of an interprofessional integrated clinical education experience to improve medical and physical therapy student comfort in treating patients with disabilities.

Purpose: The purpose of this study is to examine the impact of an interprofessional education (IPE) clinical experience for medical and physical therapy students on students' comfort levels and attitudes toward patients with disabilities. Methods: Forty students were recruited for this study, 20 from the College of Medicine and 20 from the Doctor of Physical Therapy Program at University of Central Florida with 10 students from each program self-selected into a control group or an experimental group. The experimental group attended an IPE clinical experience that included an encounter with a patient with a disability. Students completed standardized inventories on their perceptions of difficult rehabilitation situations, comfort levels, and attitudes prior to, and immediately following, the clinical experience. The control group completed the same standardized assessments. Results: Using the rehabilitation situations inventory (RSI) statistically significant changes in scores from the pre- to the post-intervention (P < 0.001) were observed. In addition, a statistically significant (P < 0.05) improvement in comfort levels was found in five of the six RSI subscales which include staff-staff interactions, families, motivation/adherence, aggression, and sexual situations. Attitudes toward disabled persons (ATDP) and interactions with disabled persons (IDP) failed to find statistically significant changes in respondent scores due to the intervention (P > 0.05). Conclusion: Both medical and physical therapy students reported increased comfort in dealing with rehabilitation situations after attending the IPE clinical experience. This supports the use of clinical encounters with individuals with disabilities as component of education on treating patients with disabilities.

The immediate effects of manual stretching and cervicothoracic junction manipulation on cervical range of motion and upper trapezius pressure pain thresholds.

INTRODUCTION: Myofascial pain is a common impairment treated with various manual interventions including spinal thrust manipulation and stretching; however, the comparative efficacy of each intervention is uncertain. Therefore, the purpose of this investigation was to evaluate thrust manipulation targeting the cervicothoracic junction compared to a manual stretch of the upper trapezius muscle on cervical range of motion and upper trapezius pressure pain thresholds (PPTs). METHODS: Healthy participants with no significant history of neck pain were randomized into a thrust manipulation group, a stretching group, or a control group. Within group differences were evaluated via a dependent t-test, and group by time interactions were evaluated by a two-way repeated measures ANOVA. RESULTS: One hundred and two participants were recruited to participate. Baseline demographics revealed no significant differences between groups. Significant group by time interactions were found for changes in PPTs for both the right and left upper trapezius. Also, significant differences were found for changes in cervical extension, as well as right and left cervical side bending favoring the treatment groups. DISCUSSION: This study demonstrates the potential independent effectiveness of spinal thrust manipulation or stretching for reducing PPTs at the upper trapezius. Future research should further evaluate the limitation of PPTs as a measure of muscle sensitivity as well as factors that may contribute to variability in the measurements among individuals seeking care.

The Short-Term Effect of Kettlebell Swings on Lumbopelvic Pressure Pain Thresholds: A Randomized Controlled Trial.

Keilman, BM, Hanney, WJ, Kolber, MJ, Pabian, PS, Salamh, PA, Rothschild, CE, and Liu, X. The short-term effect of kettlebell swings on lumbopelvic pressure pain thresholds: a randomized controlled trial. J Strength Cond Res 31(11): 3001-3009, 2017-The purpose of this study was to investigate the short-term effect of kettlebell swings (KBSs) on lumbopelvic pressure pain thresholds (PPTs) in healthy adults. Sixty participants (male = 23, female = 37, mean age = 25.12 ± 2.86 years, height = 170.73 ± 9.2 cm, mass = 70.49 ± 13.32 kg) were randomized into one of 2 groups. The experimental group performed a warm-up followed by 8 consecutive 20-second rounds of KBS with 10-second rest periods. The control group performed the warm-up alone. An evaluator blinded to group assignment, assessed PPTs immediately before and after the intervention using a handheld pressure algometer. The algometer was applied to the regions of the right paravertebral (PVM), quadratus lumborum (QL), and piriformis (PF) muscles perpendicular to the skin based on standardized palpation procedures. The participants were instructed to report when sensation changed from "comfortable pressure" to "slightly unpleasant pain." No significant group differences existed at baseline for PPTs (PVM p = 0.068; QL p = 0.134, & PF p = 0.105). Significant group by time interactions existed for each site after the interventions (PVM, p = 0.018; QL, p = 0.004; PF, p = 0.026) favoring the KBS group. Results suggest that KBSs create a reduction in muscle sensitivity to noxious pressure based on pressure algometry measurements. These findings may be due to the unique cyclic muscle contraction associated with KBSs, which has been proposed to facilitate removal of muscle metabolites. The findings of this study provide a foundation for future studies to examine the use of this type of training in patients with low back pain of a muscular etiology or postexercise muscle soreness. Furthermore, future studies should evaluate specific mechanisms for these effects.

Interprofessional management of concussion in sport.

Due to the high incidence of sports concussion, various health and medical providers are likely to encounter athletes who have sustained such an injury. Management of concussion necessitates coordinated care by the members of the sports medicine team due to its pathophysiology and complexity of management during recovery. All members of the sports medicine team must possess contemporary knowledge of concussion management as well as strong interprofessional communication skills to ensure effective care and safe return to sports participation. Therefore, the aim of this manuscript is to review the current best practices in interdisciplinary management of sports concussion with a special emphasis on the required interprofessional communication among the sports medicine team.

Endurance Times of the Thoracolumbar Musculature: Reference Values for Female Recreational Resistance Training Participants.

The assessment of thoracolumbar muscle endurance (TLME) is common among strength and conditioning professionals and clinicians desiring to quantify baseline muscle performance and determine injury risk. Reference values for such assessments are documented in the literature; however, their utility may be of limited value due to heterogeneous participant selection and limited demographic reporting. Moreover, active cohorts who engage in resistance training (RT) may reach a ceiling effect on existing reference values when testing routinely trained muscles. Thus, the purpose of this study was to establish reference values for standardized TLME tests among women who participate in recreational RT and to determine whether imbalances or asymmetries exist. Participants included 61 women aged 18-59 years who engaged in RT for at least 1 year. Flexor, extensor, and lateral flexor TLME was isometrically assessed using standardized procedures with documented reproducibility (r ≥ 0.93). Results identified significant differences (p < 0.001) between mean TLME times of flexors (163 ± 106 seconds) and extensors (105 ± 57 seconds). Left (66 ± 38 seconds) and right side bridges (61 ± 33 seconds) were comparable (p = 0.06). Flexor to extensor imbalances were more pronounced among RT participants when compared with previously reported general population reference values, suggesting a training effect or bias. Moreover, similar imbalances favoring the flexors are a documented risk factor for low back pain. Thus, training considerations inclusive of the extensors may benefit women who engage in RT as a means of mitigating risk. Individuals evaluating muscle performance should consider reference values that represent the population of interest.