Effects of a Total Motion Release (TMR®) Protocol for the Single Leg Squat on Asymmetrical Movement Patterns.

BACKGROUND: Improving single leg squat (SLS) movement symmetry may benefit rehabilitation protocols. The Total Motion Release® (TMR®) protocol has been theorized to evaluate and improve patient-perceived movement asymmetries. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate whether perceived asymmetries identified by a TMR® scoring protocol were related to biomechanical asymmetries and whether improving perceived asymmetries influenced movement mechanics. It was hypothesized that participants with perceived asymmetries would also present with biomechanical asymmetries. A secondary hypothesis was that participants would reduce their perceived asymmetries after performing the TMR® protocol and subsequently have greater biomechanical symmetry. STUDY DESIGN: Descriptive Cohort (Laboratory Study). METHODS: Twenty participants (10 female, 10 male) with self-identified bilateral differences of 10 points or greater on the TMR® scoring scale were recruited for the study. The non-preferred side was defined as the side that scored higher. 3Dimensional motion capture was used to bilaterally assess baseline SLS depth as well as hip, knee, and ankle kinematics and kinetics. For the TMR® protocol, sets of 10 SLSs were performed on the preferred leg until their perceived asymmetries were resolved (i.e., both sides scored equally), or four sets had been completed. Kinematics and kinetics were collected immediately after the intervention and after a 10-minute rest period. RESULTS: Participants had biomechanical asymmetries at baseline for knee flexion, ankle flexion, and knee moments. Following the intervention, participants had reduced TMR® scores on the non-preferred leg, and this coincided with increased knee joint moments on that side. Although perceived asymmetries were resolved after the intervention, kinematic and kinetic asymmetries at the knee and ankle were still present. CONCLUSIONS: A TMR® intervention could benefit rehabilitation protocols by reducing factors of dysfunction and increasing the ability of patients to load the non-preferred knee. Further investigations are necessary to elucidate the importance of asymmetrical movement patterns. LEVEL OF EVIDENCE: 3b.

Examining movement asymmetries during three single leg tasks using interlimb and single subject approaches.

PURPOSE: s: To examine whether healthy individuals displayed asymmetric trunk and lower extremity kinematics in the frontal and sagittal planes using both interlimb and single subject models. METHODS: Trunk, pelvis, and lower extremity kinematic waveforms were analyzed bilaterally during the single leg squat (SLS), forward step down (FSD), and lateral step down (LSD). Participants identified task specific preferred and non-preferred legs based on perceived stability for interlimb analyses. Movement patterns were also analyzed with a single subject approach that included Fisher's exact tests to assess whether asymmetries were related to the task. RESULTS: Participants were found to have increased pelvic drop on the non-preferred leg during the LSD from 41 to 77% of the movement (p = 0.01). No other bilateral differences were found for interlimb analyses. Single subject analyses indicated that no task had a greater probability of finding or not finding asymmetries. Associations were found between the FSD and SLS for frontal plane hip (p < 0.01) and knee motion (p < 0.01). CONCLUSIONS: Interlimb analyses can be influenced by intraparticipant movement variability between preferred and non-preferred legs. Movement asymmetries during single leg weightbearing are likely task dependent and a battery of tests is necessary for assessing bilateral differences.

Comparing the Immediate Effects of a Total Motion Release Warm-up and a Dynamic Warm-up Protocol on the Dominant Shoulder in Baseball Athletes.

Gamma, SC, Baker, R, May, J, Seegmiller, JG, Nasypany, A, and Iorio, SM. Comparing the immediate effects of a total motion release warm-up and a dynamic warm-up protocol on the dominant shoulder in baseball athletes. J Strength Cond Res 34(5): 1362-1368, 2020-A decrease in total range of motion (ROM) of the dominant shoulder may predispose baseball athletes to increased shoulder injury risk; the most effective technique for improving ROM is unknown. The purpose of this study was to compare the immediate effects of Total Motion Release (TMR) to a generic dynamic warm-up program in baseball athletes. Baseball athletes (n = 20) were randomly assigned to an intervention group: TMR group (TMRG; n = 10) or traditional warm-up group (TWG; n = 10). Shoulder ROM measurements were recorded for internal rotation (IR) and external rotation (ER), the intervention was applied, and postmeasurements were recorded. Each group then received the other intervention and postmeasurements were again recorded. The time main effect (p ≤ 0.001) and the time × group interaction effect were significant (p ≤ 0.001) for IR and ER. Post hoc analysis revealed that TMR produced significant increases in mean IR (p ≤ 0.005, d = 1.52) and ER (p ≤ 0.018, d = 1.22) of the dominant shoulder initially. When groups crossed-over, the TMRG experienced a decrease in mean IR and ER after the dynamic warm-up, whereas the TWG experienced a significant increase in mean IR (p ≤ 0.001, d = 3.08) and ER (p ≤ 0.001, d = 2.56) after TMR intervention. Total Motion Release increased IR and ER of the dominant shoulder more than a dynamic warm-up. Dynamic warm-up after TMR also resulted in decreased IR and ER; however, TMR after dynamic warm-up significantly improved IR and ER. Based on these results, TMR is more effective than a generic dynamic warm-up for improving dominant shoulder ROM in baseball players.

A total motion release warm-up improves dominant arm shoulder internal and external rotation in baseball players.

CONTEXT: Current literature indicates a correlation between decreased total shoulder range of motion (ROM) and internal rotation (IR) of the dominant arm and increased injury risk in throwers. The optimal method for increasing shoulder ROM, improving performance, and preventing injury is unknown. It is also unknown if treating the non-dominant arm may affect ROM on the dominant side. PURPOSE: To explore the effect of the Total Motion Release (TMR®) Trunk Twist (TT) and Arm Raise (AR) on IR and external rotation (ER) of the dominant shoulder in baseball players compared to a traditional dynamic warm-up. DESIGN: Cohort study. SETTING: University athletic training clinic and baseball field. PARTICIPANTS: Pitchers (males, n = 10; age, 18.6 ± 1.3) recruited from local baseball teams were randomly assigned two one of two groups: TMR® treatment group (TMRG; n = 5) or traditional warm-up group (TWG; n = 5). INTERVENTIONS: Baseline IR and ER goniometry range of motion (ROM) measurements were recorded. The TMRG then completed the TMR® exercises and post-intervention measurements. The TWG completed a traditional static and dynamic warm-up (e.g., lunges, power skips, sprints, sleeper stretch) and then completed post-intervention measurements. Following the completion of those measurements, the TWG completed the TMR® Trunk Twist and Arm Raise protocol and had post-intervention measurements recorded once more. MAIN OUTCOME MEASURES: ROM measures for IR and ER of the dominant shoulder. Alpha level was set at p ≤ 0.05. RESULTS: Significant differences were present for IR (p = 0.025) and ER (p = 0.014) between the TMRG and the TWG after initial intervention. Significant differences for IR were present in the TWG between baseline and TMR® intervention and traditional warm-up and TMR® intervention. For the TWG, changes in ER were not statistically significant at baseline, post-warm-up, or post- TMR® intervention. Significant differences were not present for IR (p = 0.44) or ER (p = 0.23) between groups once TMR® had been completed by both groups. CONCLUSIONS: TMR® produced larger increases in IR and ER of the throwing shoulder when compared to the TWG. Generalizability is limited, however, by the low number of participants in each group and a potential ceiling effect of attainable ROM gains. Future studies should examine if using a full TMR® treatment process is more beneficial. Additionally, future research should compare TMR® intervention to other warm-up activities or stretching protocols (e.g. resistance tubing, weighted balls) and examine its effect across other variables (e.g., injury rates, throwing velocity). LEVEL OF EVIDENCE: Clinical Evidence Based Level 2b.

Unanticipated ankle inversions are significantly different from anticipated ankle inversions during drop landings: overcoming anticipation bias.

Few ankle inversion studies have taken anticipation bias into account or collected data with an experimental design that mimics actual injury mechanisms. Twenty-three participants performed randomized single-leg vertical drop landings from 20 cm. Subjects were blinded to the landing surface (a flat force plate or 30° inversion wedge on the force plate). After each trial, participants reported whether they anticipated the landing surface. Participant responses were validated with EMG data. The protocol was repeated until four anticipated and four unanticipated landings onto the inversion wedge were recorded. Results revealed a significant main effect for landing condition. Normalized vertical ground reaction force (% body weights), maximum ankle inversion (degrees), inversion velocity (degrees/second), and time from contact to peak muscle activation (seconds) were significantly greater in unanticipated landings, and the time from peak muscle activation to maximum VGRF (second) was shorter. Unanticipated landings presented different muscle activation patterns than landings onto anticipated surfaces, which calls into question the usefulness of clinical studies that have not controlled for anticipation bias.

Gastrointestinal temperature increases and hypohydration exists after collegiate men's ice hockey participation.

The cold environments in which ice hockey players participate are counterintuitive to the predisposing factors of heat- and hypohydration-related illnesses. This population has received little consideration in hypohydration-related illness risk assessments. Protective equipment, multiple clothing layers, and performance intensity may predispose these athletes to significant decreases in hydration and increases in core temperature. The purpose of this study was to measure hydration status and gastrointestinal temperature (T(GI)) in male ice hockey players during practice sessions that focused on pre-season skill development and cardiovascular conditioning. The study used a repeated measures design. Data were collected in a collegiate ice hockey rink (ambient temperature = 6.03 +/- 1.65 degrees C; relative humidity = 40.4 +/- 11.89%). Seventeen ice hockey players (age = 20.6 +/- 1.1, height = 180 +/- 5 cm, mass = 85.04 +/- 7.9 kg) volunteered for this study. Urine-specific gravity (USG) and body weight were measured before and after two 110-minute practice sessions. Urine reagent strips measured USG. Calibrated CorTemp (HQ, Inc., Palmetto, FL, USA) radiofrequency telemetered thermometers collected T(GI) before, during, and after two 110-minute practice sessions. Individual participant sweat rates were calculated. Data from both sessions were pooled. T(GI) (p < 0.0001), and USG (p < 0.0001) increased over the 110-minute session. Post-exercise body weight (83.9 +/- 7.6 kg) was statistically lower (p < 0.001) than the pre-exercise weight (85.0 +/- 7.9 kg). Sweat rates were calculated to be 0.83 +/- 0.50 L.h(-1). These male ice hockey players become hypohydrated during participation potentially predisposing them to dehydration-related illnesses. This change in hydration status resulted in a gastrointestinal temperature increase and significant weight loss during activity. Prevention and rehydration strategies such as those developed by the American College of Sports Medicine and National Athletic Trainers' Association should be implemented to reduce the possibility of heat-related illness for this population.

Physiological profile of women's Lacrosse players.

Increasing participation rates for women's lacrosse necessitate a clear understanding of fitness parameters for this athlete group. However, limited sport-specific information is available. We described the physiological profile of an NCAA Division I women's lacrosse team to provide current data for this specific athlete group. A descriptive analysis was used to assess physiologic variables. Twenty-four members (age 20.0 +/- 1.4 years, mass 64.7 +/- 9.6 kg, height 163.2 +/- 25.6 cm) of an NCAA Division I women's lacrosse team volunteered and provided consent. Fitness tests were conducted by the same researcher and were selected from standard physical fitness assessments. Tests included cardiovascular endurance (Bruce Protocol VO2max test and 1-mile run), flexibility (sit-and-reach test), muscular endurance (push-ups, sit-ups, and 60% of 1RM back squat), muscular strength (one-repetition maximum [1RM] back squat and 1RM bench press), body composition (BOD POD), muscle torque (quadriceps maximal voluntary isometric contraction), grip strength (hand dynamometer), vertical jump (Vertec vertical column), endurance strength (100- and 200-yard sprints), and Q-angle. Our results indicate that our sample of lacrosse players exhibited similar fitness characteristics to basketball, soccer, and track athletes. However, we found only average flexibility and a higher percentage of body fat, indicating possible areas for improvement in lacrosse training programs.

Perceptions of quality for graduate athletic training education.

CONTEXT: Accreditation is generally considered the primary mechanism for quality assurance in higher education, but disagreement often exists between accrediting agencies and the perceptions of professionals who feel the accrediting body has failed to meet its quality control function. For accreditation to have value, it must be a meaningful indicator of quality and be viewed as such. OBJECTIVE: To identify the predominant contributors to quality for postcertification graduate education as perceived by athletic training educators and to compare results among respondents with different education levels, academic ranks, tenure classifications, and program affiliations. DESIGN: Non-experimental descriptive survey. SETTING: 2003 National Athletic Trainers' Association Educators' Conference. Patients or Other Participant(s): Of a convenience sample of 353 athletic training educators, 194 (55%) submitted usable questionnaires. Males accounted for 115 (59%) respondents and females for 79 (41%). Of the 14 National Athletic Trainers' Association-accredited postcertification graduate education programs, 12 were represented. MAIN OUTCOME MEASURE(S): Quantitative data for closed-ended questionnaire items were analyzed using descriptive statistics and measures of central tendency, with composite mean scores for each item used for comparisons. Qualitative data were coded according to major themes and analyzed. RESULTS: Support for accreditation at the postcertification graduate education level was moderate (mean = 3.08 +/- 0.811 on a 4-point scale). Subjects with doctoral degrees (n = 88) indicated that research contributed significantly more to quality (mean = 3.38 +/- 0.636) than did those with master's degrees (n = 106, mean = 2.97 +/- 0.786). Respondents with master's degrees stated that clinical education was a greater contributor to quality (mean = 3.76 +/- 0.491) than did those with doctoral degrees (3.44 +/- 0.663). CONCLUSIONS: The educators showed agreement for most quality indicators. The greatest contributors to program quality were program curriculum; adequate faculty, staff, and administrative support; evaluation; clinical education; and research.

Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study.

OBJECTIVE: Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief. However, according to the results of in vivo studies, the effectiveness of this modality varies. Our purpose was to assess the putative effects of LLLT on healing using an experimental wound model. DESIGN AND SETTING: We used a randomized, triple-blind, placebo-controlled design with 2 within-subjects factors (wound and time) and 1 between-subjects factor (group). Data were collected in the laboratory setting. SUBJECTS: Twenty-two healthy subjects (age = 21 +/- 1 years, height = 175.6 +/- 9.8 cm, mass = 76.2 +/- 14.2 kg). MEASUREMENTS: Two standardized 1.27-cm(2) abrasions were induced on the anterior forearm. After wound cleaning, standardized digital photos were recorded. Each subject then received LLLT (8 J/cm(2); treatment time = 2 minutes, 5 seconds; pulse rate = 700 Hz) to 1 of the 2 randomly chosen wounds from either a laser or a sham 46-diode cluster head. Subjects reported back to the laboratory on days 2 to 10 to be photographed and receive LLLT and on day 20 to be photographed. Data were analyzed for wound contraction (area), color changes (chromatic red), and luminance. RESULTS: A group x wound x time interaction was detected for area measurements. At days 6, 8, and 10, follow-up testing revealed that the laser group had smaller wounds than the sham group for both the treated and the untreated wounds (P < .05). No group x wound x time differences were detected for chromatic red or luminance. CONCLUSIONS: The LLLT resulted in enhanced healing as measured by wound contraction. The untreated wounds in subjects treated with LLLT contracted more than the wounds in the sham group, so LLLT may produce an indirect healing effect on surrounding tissues. These data indicate that LLLT is an effective modality to facilitate wound contraction of partial-thickness wounds.

Ground Reaction Forces Among Gymnasts and Recreational Athletes in Drop Landings.

OBJECTIVE: To compare vertical ground reaction forces among gymnasts and recreational athletes during drop landings from 30-, 60-, and 90-cm heights. DESIGN AND SETTING: Two subject groups, intercollegiate gymnasts and college-aged recreational athletes, participated in this study. Subjects completed 10 landing trials onto a force platform at each height. SUBJECTS: Ten female competitive gymnasts (height = 1.57 +/- 0.02 m, mass = 55.4 +/- 7.3 kg) and 10 female recreational athletes (height = 1.63 +/- 0.06 m, mass = 59.6 +/- 4.9 kg) volunteered for this study. MEASUREMENTS: Measurements of first peak-force magnitude (F1), time to F1 (T1), impulse to F1, second peak-force magnitude (F2), time to F2 (T2), and impulse to F2 were compiled to describe the ground reaction force profile for each trial at 30-, 60-, and 90-cm platform heights. A 2 x 3 (group x height) mixed-factors analysis of variance was calculated for each of the 6 variables. RESULTS: The group-by-height interaction was significant for F1, F2, and impulse to F2. Tukey post hoc analyses revealed significantly higher values for the gymnasts than for the recreational athletes at 60- and 90-cm heights for F1 and F2 magnitudes. Differences between groups for T1, T2, impulse to F1, and impulse to F2 were not statistically significant at any height. CONCLUSIONS: Drop landings performed by female gymnasts at 60- and 90-cm heights exhibited higher vertical ground reaction forces than drop landings performed by female recreational athletes. High ground reaction forces experienced by gymnasts during landings may contribute to the incidence of lower extremity injuries.