Meghan Warren

Reliability and normative values for the foot mobility magnitude: a composite measure of vertical and medial-lateral mobility of the midfoot

BackgroundA study was conducted to determine the reliability and minimal detectable change for a new composite measure of the vertical and medial-lateral mobility of the midfoot called the foot mobility magnitude.MethodsThree hundred and forty-five healthy participants volunteered to take part in the study. The change in dorsal arch height between weight bearing and non-weight bearing as well as the change in midfoot width between weight bearing and non-weight bearing were measured at 50% of total foot length and used to calculate the foot mobility magnitude. The reliability and minimal detectable change for the measurements were then determined based on the assessment of the measurements by three raters with different levels of clinical experience.ResultsThe change in dorsal arch height between weight bearing and non-weight bearing, midfoot width between weight bearing and non-weight bearing, and the foot mobility magnitude were shown to have high levels of intra-rater and inter-rater reliability. Normative data are provided for the left and right feet of both the female (n = 211) and male (n = 134) subjects.ConclusionWhile the measurements of navicular drop and drift have been used as a clinical method to assess both the vertical and medial-lateral mobility of the midfoot, poor to fair levels of inter-rater reliability have been reported. The results of the current study suggest that the foot mobility magnitude provides the clinician and researcher with a highly reliable measure of vertical and medial-lateral midfoot mobility.

Exercise Effect on Oxidative Stress Is Independent of Change in Estrogen Metabolism

Purpose: The effect of exercise training on lipid peroxidation and endogenous estrogens is not well understood in premenopausal women. Exercise effects on these variables could mediate observed associations of exercise with hormonally related cancers, including breast cancer. The purpose of the study is to determine the effect of 15 weeks of aerobic exercise on lipid peroxidation, endogenous estrogens, and body composition in young, healthy eumenorrheic women. Methods: Fifteen sedentary premenopausal women (18-25 years) participated. Pre- and post-exercise training urine collection (three 24-h samples) started 48 h after most recent exercise session for analysis of a marker of lipid peroxidation (F2-isoprostane) and endogenous estrogens, including 2-hydroxyestrogens, 4-hydroxyestrogens, 16-α-hydroxyestrone, and ratios of these metabolites (2:16, 2:4). Body composition was measured by dual-energy X-ray absorptiometry, and F2-isoprostanes and estrogens were measured by gas chromatography-mass spectrometry. Results: Aerobic exercise resulted in a 34% decrease in F2-isoprostane (P = 0.02), a 10% increase in fitness (P = 0.004), a 1.2 kg decrease in body mass (P = 0.007), and a 1.8 kg decrease in fat mass (P = 0.04). No significant changes were noted in estrogens. Conclusions: The effect of exercise training on oxidative stress may be relevant to risk for hormonally related cancers. (Cancer Epidemiol Biomarkers Prev 2008;17(1):220–3)

Association of Y Balance Test Reach Asymmetry and Injury in Division I Athletes.

PURPOSE The Y balance test (YBT) is a screen of dynamic balance requiring stance leg balance while the contralateral leg reaches in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions. YBT has been proposed as a screen for injury risk; however, limited research has examined the association between YBT and injury. The purpose of this study was to examine the association between YBT (asymmetry and composite score (CS)) and noncontact injury in a sample of Division I (DI) college athletes from multiple sports. METHODS DI college athletes were screened with the YBT during the preparticipation examination to determine asymmetry (absolute difference between legs in ANT, PL, and PM) and CS (summed average of right/left ANT, PL, and PM normalized to leg length). Participants were followed throughout the sport season, and noncontact injuries requiring athletic training staff intervention were recorded for analysis. Demographic variables between injured and uninjured athletes were assessed with independent t-tests. Receiver operating characteristic (ROC) curves determined optimal cut points for predicting injury on the basis of CS and asymmetry. CS was analyzed as a continuous variable, as ROC curves were unable to maximize sensitivity and specificity. Logistic regression models adjusted for sport and previous injury determined the odds of injury on the basis of asymmetry and CS. RESULTS One hundred and eighty-four participants were included in analysis; 81 were injured. ROC curves determined asymmetry >4 cm (sensitivity, 59%; specificity, 72%) as the optimal cut point for predicting injury. Only ANT asymmetry was significantly associated with noncontact injury (odds ratio, 2.33; 95% confidence interval, 1.15-4.76). CONCLUSIONS ANT asymmetry >4 cm was associated with increased risk of noncontact injury. CS in this sample of DI athletes was not associated with increased risk of injury.

Association of the Functional Movement Screen With Injuries in Division I Athletes

CONTEXT The Functional Movement Screen (FMS) evaluates performance in 7 fundamental movement patterns using a 4-point scale. Previous studies have reported increased injury risk with a composite score (CS) of 14/21 or less; these studies were limited to specific sports and injury definition. OBJECTIVE To examine the association between FMS CS and movement pattern scores and acute noncontact and overuse musculoskeletal injuries in division I college athletes. An exploratory objective was to assess the association between injury and FMS movement pattern asymmetry. DESIGN Prospective cohort. SETTING College athletic facilities. PARTICIPANTS 167 injury-free, college basketball, football, volleyball, cross country, track and field, swimming/ diving, soccer, golf, and tennis athletes (males = 89). INTERVENTION The FMS was administered during pre-participation examination. MAIN OUTCOME MEASURE Noncontact or overuse injuries that required intervention from the athletic trainer during the sport season. RESULTS FMS CS was not different between those injured (n = 74; 14.3 ± 2.5) and those not (14.1 ± 2.4; P = .57). No point on the ROC curve maximized sensitivity and specificity; therefore previously published cut-point was used for analysis with injury (≤ 14 [n = 92]). After adjustment, no statistically significant association between FMS CS and injury (odds ratio [OR] = 1.01, 95% CI 0.53-1.91) existed. Lunge was the only movement pattern that was associated with injury; those scoring 2 were less likely to have an injury vs those who scored 3 (OR = 0.21, 95% CI 0.08-0.59). There was also no association between FMS movement pattern asymmetry and injury. CONCLUSION FMS CS, movement patterns, and asymmetry were poor predictors of noncontact and overuse injury in this cohort of division I athletes.

A Web-Based Survey of the Relationship Between Buddhist Religious Practices, Health, and Psychological Characteristics: Research Methods and Preliminary Results

A Web-based survey was conducted to study the religious and health practices, medical history and psychological characteristics among Buddhist practitioners. This report describes the development, advertisement, administration and preliminary results of the survey. Over 1200 Buddhist practitioners responded. Electronic advertisements were the most effective means of recruiting participants. Survey participants were mostly well educated with high incomes and white. Participants engaged in Buddhist practices such as meditation, attending meetings and obtaining instruction from a monk or nun, and practiced healthful behaviors such as regular physical activity and not smoking. Buddhist meditative practice was related to psychological mindfulness and general health.

Variations in foot posture and mobility between individuals with patellofemoral pain and those in a control group.

BACKGROUND We sought to determine whether foot posture and foot mobility were increased in individuals with patellofemoral pain syndrome compared with individuals in a control group. METHODS A nested case-control design was used with two controls matched to each patient by sex and age (±1 year). Participants included 43 individuals with a history of unilateral or bilateral patellofemoral pain syndrome and 86 participants in a control group. Data collected included height, weight, and five different measures of foot height and width in weightbearing and nonweightbearing that have been previously shown to have high levels of reliability. RESULTS Individuals with patellofemoral pain syndrome were found to be four times more likely (odds ratio, 4.04; 95% confidence interval, 1.45-11.32) to have a larger-than-normal difference between nonweightbearing and weightbearing arch height compared with those in the control group. The mean values for difference in arch height and foot mobility magnitude were also statistically significant between the patient and control groups. Foot posture, as determined using the arch height ratio, was not significant between groups (odds ratio, 0.94; 95% confidence interval, 0.34-2.61). CONCLUSIONS Although foot posture may not be different between individuals with patellofemoral pain syndrome and controls, foot mobility assessed using difference in arch height and foot mobility magnitude is different between the two groups.

Injury History, Sex, and Performance on the Functional Movement Screen and Y Balance Test

CONTEXT Research is limited regarding the effects of injury or surgery history and sex on the Functional Movement Screen (FMS) and Y Balance Test (YBT). OBJECTIVE To determine if injury or surgery history or sex affected results on the FMS and YBT. DESIGN Cross-sectional study. SETTING Athletic training facilities. PATIENTS OR OTHER PARTICIPANTS A total of 200 National Collegiate Athletic Association Division I female (n = 92; age = 20.0 ± 1.4 years, body mass index = 22.8 ± 3.1 kg/m(2)) and male (n = 108; age = 20.0 ± 1.5 years, body mass index = 27.0 ± 4.6 kg/m(2)) athletes were screened; 170 completed the FMS, and 190 completed the YBT. INTERVENTION(S) A self-reported questionnaire identified injury or surgery history and sex. The FMS assessed movement during the patterns of deep squat, hurdle step, in-line lunge, shoulder mobility, impingement-clearing test, straight-leg raise, trunk stability push-up, press-up clearing test, rotary stability, and posterior-rocking clearing test. The YBT assessed balance while participants reached in anterior, posteromedial, and posterolateral directions. MAIN OUTCOME MEASURE(S) The FMS composite score (CS; range, 0-21) and movement pattern score (range, 0-3), the YBT CS (% lower extremity length), and YBT anterior, posteromedial, and posterolateral asymmetry (difference between limbs in centimeters). Independent-samples t tests established differences in mean FMS CS, YBT CS, and YBT asymmetry. The Mann-Whitney U test identified differences in FMS movement patterns. RESULTS We found lower overall FMS CSs for the following injuries or surgeries: hip (injured = 12.7 ± 3.1, uninjured = 14.4 ± 2.3; P = .005), elbow (injured = 12.1 ± 2.8, uninjured = 14.3 ± 2.4; P = .02), and hand (injured = 12.3 ± 2.9, uninjured = 14.3 ± 2.3; P = .006) injuries and shoulder surgery (surgery = 12.0 ± 1.0, no surgery = 14.3 ± 2.4; P < .001). We observed worse FMS movement pattern performance for knee surgery (rotary stability: P = .03), hip injury (deep squat and hurdle: P < .042 for both), hip surgery (hurdle and lunge: P < .01 for both), shoulder injury (shoulder and hand injury: P < .02 for both), and shoulder surgery (shoulder: P < .02). We found better FMS movement pattern performance for trunk/back injury (deep squat: P = .02) and ankle injury (lunge: P = .01). Female athletes performed worse in FMS movement patterns for trunk (P < .001) and rotary (P = .01) stability but better in the lunge (P = .008), shoulder mobility (P < .001), and straight-leg raise (P < .001). Anterior asymmetry was greater for male athletes (P = .02). CONCLUSIONS Injury history and sex affected FMS and YBT performance. Researchers should consider adjusting for confounders.

Strength Training Effects on Bone Mineral Content and Density in Premenopausal Women

PURPOSE Mechanical loading, such as that seen with physical activity, is thought to be the primary factor influencing bone strength. Previous randomized studies that assessed the effect of strength training on bone in premenopausal women report inconsistent results. The analysis herein examines the effect of a strength training program following published guidelines (US Department of Health and Human Services) on bone mineral content (BMC) and areal bone mineral content (aBMD) in the proximal femur and lumbar spine in premenopausal women. METHODS One hundred and forty-eight overweight, sedentary, premenopausal women aged 25-44 were randomized to progressive strength training (ST, n = 72) or standard care (CO, n = 76) for 2 yr. Measurements occurred at baseline, 1 yr, and 2 yr. Proximal femur and lumbar spine BMC and aBMD were measured by dual energy x-ray absorptiometry. Intention-to-treat analyses were completed, and repeated-measures ANCOVA adjusted for baseline height and weight was used to assess the effect of strength training on bone. RESULTS aBMD showed little change and did not differ between groups at any site. Femoral neck BMC showed a significant difference in the slopes between ST and CO (P = 0.04) with no change in the ST group and a 1.5% decrease in the CO. There were no significant between-group differences at any other measurement site. CONCLUSION Strength training had no effect on aBMD after 2 yr of strength training. Femoral neck BMC decreased in CO and had no change in ST. Because there was no change in aBMD, strength training may have influenced bone size. Research to better understand changes in bone dimensions and geometry with strength training in premenopausal women is warranted.

Interrater and Intrarater Reliability of the Tuck Jump Assessment by Health Professionals of Varied Educational Backgrounds

Objective. The Tuck Jump Assessment (TJA), a clinical plyometric assessment, identifies 10 jumping and landing technique flaws. The study objective was to investigate TJA interrater and intrarater reliability with raters of different educational and clinical backgrounds. Methods. 40 participants were video recorded performing the TJA using published protocol and instructions. Five raters of varied educational and clinical backgrounds scored the TJA. Each score of the 10 technique flaws was summed for the total TJA score. Approximately one month later, 3 raters scored the videos again. Intraclass correlation coefficients determined interrater (5 and 3 raters for first and second session, resp.) and intrarater (3 raters) reliability. Results. Interrater reliability with 5 raters was poor (ICC = 0.47; 95% confidence intervals (CI) 0.33–0.62). Interrater reliability between 3 raters who completed 2 scoring sessions improved from 0.52 (95% CI 0.35–0.68) for session one to 0.69 (95% CI 0.55–0.81) for session two. Intrarater reliability was poor to moderate, ranging from 0.44 (95% CI 0.22–0.68) to 0.72 (95% CI 0.55–0.84). Conclusion. Published protocol and training of raters were insufficient to allow consistent TJA scoring. There may be a learned effect with the TJA since interrater reliability improved with repetition. TJA instructions and training should be modified and enhanced before clinical implementation.

Use of clinical movement screening tests to predict injury in sport

Clinical movement screening tests are gaining popularity as a means to determine injury risk and to implement training programs to prevent sport injury. While these screens are being used readily in the clinical field, it is only recently that some of these have started to gain attention from a research perspective. This limits applicability and poses questions to the validity, and in some cases the reliability, of the clinical movement tests as they relate to injury prediction, intervention, and prevention. This editorial will review the following clinical movement screening tests: Functional Movement Screen™, Star Excursion Balance Test, Y Balance Test, Drop Jump Screening Test, Landing Error Scoring System, and the Tuck Jump Analysis in regards to test administration, reliability, validity, factors that affect test performance, intervention programs, and usefulness for injury prediction. It is important to review the aforementioned factors for each of these clinical screening tests as this may help clinicians interpret the current body of literature. While each of these screening tests were developed by clinicians based on what appears to be clinical practice, this paper brings to light that this is a need for collaboration between clinicians and researchers to ensure validity of clinically meaningful tests so that they are used appropriately in future clinical practice. Further, this editorial may help to identify where the research is lacking and, thus, drive future research questions in regards to applicability and appropriateness of clinical movement screening tools.