Jason Hugentobler

The back squat: A proposed assessment of functional deficits and technical factors that limit performance

ABSTRACT FUNDAMENTAL MOVEMENT COMPETENCY IS ESSENTIAL FOR PHYSICAL ACTIVITY PARTICIPATION AND FOR REDUCING INJURY RISK, WHICH ARE BOTH KEY ELEMENTS OF HEALTH PROMOTION. THE SQUAT MOVEMENT PATTERN IS ARGUABLY ONE OF THE MOST CRITICAL FUNDAMENTAL MOVEMENTS NECESSARY TO IMPROVE SPORT PERFORMANCE, TO REDUCE INJURY RISK, AND TO SUPPORT LIFELONG PHYSICAL ACTIVITY. BASED ON CURRENT EVIDENCE, THIS FIRST (1 OF 2) REPORT DECONSTRUCTS THE TECHNICAL PERFORMANCE OF THE BACK SQUAT AND PRESENTS A NOVEL DYNAMIC SCREENING TOOL THAT INCORPORATES IDENTIFICATION TECHNIQUES FOR KNOWN FUNCTIONAL DEFICITS. THE FOLLOW-UP REPORT WILL OUTLINE TARGETED CORRECTIVE METHODOLOGY FOR EACH OF THESE FUNCTIONAL DEFICITS.

Aerobic Exercise for Adolescents With Prolonged Symptoms After Mild Traumatic Brain Injury: An Exploratory Randomized Clinical Trial

Objective: To describe the methodology and report primary outcomes of an exploratory randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after a mild traumatic brain injury (mTBI) in adolescents. Setting: Outpatient research setting. Participants: Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between 4 and 16 weeks of persistent symptoms. Design: Partially blinded, pilot RCT of subsymptom exacerbation aerobic training compared with a full-body stretching program. Main Measures: The primary outcome was postinjury symptom improvement assessed by the adolescents self-reported Post-Concussion Symptom Inventory (PCSI) repeated for at least 6 weeks of the intervention. Parent-reported PCSI and adherence are also described. Results: Twenty-two percent of eligible participants enrolled in the trial. Repeated-measures analysis of variance via mixed-models analysis demonstrated a significant group × time interaction with self-reported PCSI ratings, indicating a greater rate of improvement in the subsymptom exacerbation aerobic training group than in the full-body stretching group (F = 4.11, P = .044). Adherence to the home exercise programs was lower in the subsymptom exacerbation aerobic training group compared with the full-body stretching group (mean [SD] times per week = 4.42 [1.95] vs 5.85 [1.37], P < .0001) over the duration of the study. Conclusion: Findings from this exploratory RCT suggest subsymptom exacerbation aerobic training is potentially beneficial for adolescents with persistent symptoms after an mTBI. These findings and other recent research support the potential benefit of active rehabilitation programs for adolescents with persistent symptoms after an mTBI. Larger replication studies are needed to verify findings and improve generalizability. Future work should focus on determining the optimal type, timing, and intensity of active rehabilitation programs and characteristics of individuals most likely to benefit.

Postconcussion Postural Sway Variability Changes in Youth: The Benefit of Structural Variability Analyses

Purpose: The purpose of this study was to evaluate the utility of postural sway variability as a potential assessment to detect altered postural sway in youth with symptoms related to a concussion. Methods: Forty participants (20 who were healthy and 20 who were injured) aged 10 to 16 years were assessed using the Balance Error Scoring System (BESS) and postural sway variability analyses applied to center-of-pressure data captured using a force plate. Results: Significant differences were observed between the 2 groups for postural sway variability metrics but not for the BESS. Specifically, path length was shorter and Sample and Renyi Entropies were more regular for the participants who were injured compared with the participants who were healthy (P < .05). Conclusion: The results of this study indicate that postural sway variability may be a more valid measure than the BESS to detect postconcussion alterations in postural control in young athletes.

Influence of Age on Postconcussive Postural Control Measures and Future Implications for Assessment.

Objective:To examine the influence of age, sex, attention-deficit hyperactivity disorder (ADHD) status, previous history of concussion, and days since injury on postconcussion postural control assessment in adolescents who have suffered a concussion. Design:Prospective cohort study. Setting:Hospital-based outpatient clinic. Participants:Seventy-one participants (42 males; 29 females) with mean age 14.14 ± 2.44. Independent Variables:Age, sex, previous concussion history, ADHD status, total and severity of postconcussion symptoms, and days since injury. Main Outcome Measures:Total Balance Error Scoring System score, path length, center-of-pressure (COP) area, sample entropy, and Romberg quotient. Results:Pearson product–moment correlation coefficients were calculated to test for potential associations between the continuous participant characteristics and the postural control variables. Spearman correlation was used to test the association between symptom severity and the postural control variables. Standard multiple regression was used to model the extent to which participant characteristics accounted for the variance in the postural sway variables. Age was significantly associated with all of the postural sway variables except COP area for the eyes open condition and sample entropy in the anterior–posterior direction for the eyes closed condition. Sex, ADHD status, and previous concussion history did not significantly predict postural control scores. Conclusions:Age significantly influences scores on common postconcussion postural control assessments. Clinical Relevance:This study demonstrates that age is a critical factor that needs to be accounted for to improve the clinical appropriateness and utility of current postconcussion postural control assessments.

The Back Squat: Targeted Training Techniques to Correct Functional Deficits and Technical Factors That Limit Performance

ABSTRACT THE BACK SQUAT IS A WELL-RESEARCHED AND WIDELY USED EXERCISE TO ENHANCE FUNDAMENTAL MOVEMENT COMPETENCY THAT CREATES A FOUNDATION FOR OPTIMAL MECHANICAL STRATEGIES DURING A BROAD RANGE OF ACTIVITIES. THE PRIMARY COMMENTARY INTRODUCED THE BACK SQUAT ASSESSMENT (BSA): A CRITERION-BASED ASSESSMENT OF THE BACK SQUAT THAT DELINEATES 30 POTENTIALLY OBSERVABLE FUNCTIONAL DEFICITS. THIS FOLLOW-UP COMMENTARY PROVIDES A TARGETED SYSTEM OF TRAINING CUES AND EXERCISES TO SUPPLEMENT THE BSA TO GUIDE CORRECTIVE INTERVENTION. WE PROPOSE A CRITERION-DRIVEN APPROACH TO CORRECTIVE EXERCISE THAT CAN SUPPORT PRACTITIONERS IN THEIR GOAL TO HELP INDIVIDUALS ACHIEVE MOVEMENT COMPETENCY IN THE BACK SQUAT.