Paul A. Salamh

The reliability, minimal detectable change and concurrent validity of a gravity-based bubble inclinometer and iphone application for measuring standing lumbar lordosis

Abstract Purpose: To investigate the reliability, minimal detectable change (MDC90) and concurrent validity of a gravity-based bubble inclinometer (inclinometer) and iPhone® application for measuring standing lumbar lordosis. Methods: Two investigators used both an inclinometer and an iPhone® with an inclinometer application to measure lumbar lordosis of 30 asymptomatic participants. Results: ICC models 3,k and 2,k were used for the intrarater and interrater analysis, respectively. Good interrater and intrarater reliability was present for the inclinometer with Intraclass Correlation Coefficients (ICC) of 0.90 and 0.85, respectively and the iPhone® application with ICC values of 0.96 and 0.81. The minimal detectable change (MDC90) indicates that a change greater than or equal to 7° and 6° is needed to exceed the threshold of error using the iPhone® and inclinometer, respectively. The concurrent validity between the two instruments was good with a Pearson product-moment coefficient of correlation (r) of 0.86 for both raters. Ninety-five percent limits of agreement identified differences ranging from 9° greater in regards to the iPhone® to 8° less regarding the inclinometer. Conclusion: Both the inclinometer and iPhone® application possess good interrater reliability, intrarater reliability and concurrent validity for measuring standing lumbar lordosis. This investigation provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying standing lumbar lordosis. Clinicians should recognize potential individual differences when using these devices interchangeably.

Inter-rater reliability of select physical examination procedures in patients with neck pain.

Abstract This study evaluated the inter-rater reliability of select examination procedures in patients with neck pain (NP) conducted over a 24- to 48-h period. Twenty-two patients with mechanical NP participated in a standardized examination. One examiner performed standardized examination procedures and a second blinded examiner repeated the procedures 24–48 h later with no treatment administered between examinations. Inter-rater reliability was calculated with the Cohen Kappa and weighted Kappa for ordinal data while continuous level data were calculated using an intraclass correlation coefficient model 2,1 (ICC2,1). Coefficients for categorical variables ranged from poor to moderate agreement (−0.22 to 0.70 Kappa) and coefficients for continuous data ranged from slight to moderate (ICC2,1 0.28–0.74). The standard error of measurement for cervical range of motion ranged from 5.3° to 9.9° while the minimal detectable change ranged from 12.5° to 23.1°. This study is the first to report inter-rater reliability values for select components of the cervical examination in those patients with NP performed 24–48 h after the initial examination. There was considerably less reliability when compared to previous studies, thus clinicians should consider how the passage of time may influence variability in examination findings over a 24- to 48-h period.

Effect of Scapular Stabilization During Horizontal Adduction Stretching on Passive Internal Rotation and Posterior Shoulder Tightness in Young Women Volleyball Athletes: A Randomized Controlled Trial

OBJECTIVE To evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR). DESIGN Randomized controlled trial with single blinding. SETTING Athletic club. PARTICIPANTS Asymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60). INTERVENTIONS Subjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups. MAIN OUTCOME MEASURES Range of motion measurements of PST and IR were performed on the athletes dominant shoulder prior to and immediately after the intervention. RESULTS Baseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P<.001). Measurements of IR were also significantly different between groups, with a mean angle of 51°±14° among the scapular stabilization group and 43°±9° among the nonstabilization group (P=.006). CONCLUSIONS Horizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization.

Clinimetric evaluation of the disabilities of the arm, shoulder, and hand (DASH) and QuickDASH questionnaires for patients with shoulder disorders

Abstract Background: The disability of the shoulder, arm, and hand (DASH) and shortened version QuickDASH instruments are self-report questionnaires designed to measure physical function and symptoms in patients with upper-extremity disorders. An understanding of the clinimetric properties of these instruments may guide clinicians and researchers in their use. Objective: To systematically review the clinimetric properties of the DASH and QuickDASH for use among individuals with shoulder disorders. Methods: A search was conducted using Medline, CINAHL, SPORTDiscus, AMED, and PEDro from 1996 to July 2013 using the following keywords independently and in combination: disabilities of the shoulder, arm, and hand; DASH, QuickDASH, and shoulder. Articles retained were inclusive of at least one clinimetric property of the DASH or QuickDASH as the main focus of the study. Articles retained for review after meeting inclusion criteria were then cross referenced. Results: Eighteen articles were ultimately retained for the review. The clinimetric properties of the DASH and QuickDASH were comparable across various shoulder pathologies including both non-operative and post-surgical cohorts. Both instruments possess good reliability and internal consistency. Construct validity is present in both instruments when correlated to other physical and non-physical outcome measures. Moreover, each instrument is responsive and sensitive to change when compared to global and specific measures of improvement. The administrative and respondent burden is somewhat higher for the DASH when compared to the QuickDASH. Conclusions: Both instruments possess desirable clinimetric properties including reliability, validity, and responsiveness. The QuickDASH offers a more efficient means of identifying baseline function and monitoring outcomes.

Characteristics of shoulder impingement in the recreational weight-training population.

Abstract Kolber, MJ, Cheatham, SW, Salamh, PA, and Hanney, WJ. Characteristics of shoulder impingement in the recreational weight-training population. J Strength Cond Res 28(4): 1081–1089, 2014—Despite reports implicating subacromial impingement syndrome (SIS) as an etiologic source of shoulder pain among weight-training (WT) participants, a paucity of case-controlled evidence exists to support this premise. The purpose of this study was to determine whether WT participants present with characteristics of SIS. Additionally, we investigated the role of exercise selection among those identified as having SIS. Seventy-seven (154 shoulders) men (mean age, 28) were recruited, including 46 individuals who engaged in WT a minimum of 2 days per week; and 31 controls with no history of WT participation. Before testing, participants completed a questionnaire summarizing their training patterns. On completing questionnaire, 2 previously validated tests used to identify SIS were performed on both groups and included the painful arc sign and Hawkins-Kennedy test. When clustered, these tests have a positive likelihood ratio of 5.0 for identifying SIS when compared with diagnostic gold standards. Analysis identified significant between-group differences in the combined presence of a positive painful arc and Hawkins-Kennedy (p < 0.001) test. A significant association existed between clinical characteristics of SIS (p ⩽ 0.004) and both lateral deltoid raises and upright rows above 90°. Conversely, a significant inverse association was found between external rotator strengthening and characteristics of SIS. Results suggest that WT participants may be predisposed to SIS. Avoiding performance of lateral deltoid raises and upright rows beyond an angle of 90° and efforts to strengthen the external rotators may serve as a useful means to mitigate characteristics associated with SIS.

The reliability and validity of measurements designed to quantify posterior shoulder tightness

Abstract Background: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders; thus, reliable and valid methods for quantifying PST are necessary. Objectives: To systematically review the literature pertaining to the reliability and validity of PST measurements. Methods: Three investigators independently performed an electronic search using the MEDLINE-PubMed, SPORTDiscus, and CINAHL databases. Inclusion criteria consisted of English studies published in peer-reviewed journals that identified the reliability and/or validity of a PST measurement method as the primary focus. Results: A total of 2860 articles were initially identified with 11 retained for final review. Two measurement procedures were reported that included supine and side lying horizontal adduction with scapular stabilization. PST was quantified with goniometry, inclinometry, and linear techniques. Intra-rater reliability ranged from intraclass correlation coefficient (ICC) = 0.;40 to 0.;96, whereas inter-rater reliability ranged from ICC = 0.;69 to 0.;91. Reliability among symptomatic and asymptomatic participants was comparable and there appeared to be no advantage of one measurement procedure versus another. A trend of higher reliability for inclinometric measurements was identified. In regard to convergent validity researchers reported correlations of r = 0.;35–0.;88 between the aforementioned measurement techniques and internal rotation (IR). Conclusion: PST measurement procedures have poor-to-good reliability and demonstrate convergence when compared to IR. An advantage of goniometry and inclinometry lies in their ability to gather ratio data, which may be used for inter-subject comparison unlike linear measurement techniques. No studies investigated PST measurements in the post-operative population suggesting a need for future research.

Post-rehabilitation Exercise Considerations Following Total Shoulder Arthroplasty

ABSTRACT JOINT REPLACEMENT IS A VIABLE INTERVENTION OPTION FOR INDIVIDUALS WITH VARIOUS ARTHRITIC SHOULDER PATHOLOGIES THAT HAVE BEEN REFRACTORY TO CONSERVATIVE TREATMENT MEASURES. CONSIDERING THE COMPLICATIONS AND RISKS ASSOCIATED WITH TOTAL SHOULDER ARTHROPLASTY, INDIVIDUALS WILL HAVE PERSISTENT IMPAIRMENTS THAT THE STRENGTH AND CONDITIONING PROFESSIONAL MAY ENCOUNTER, MAKING IT ESSENTIAL FOR THEM TO BE FAMILIAR WITH THE SURGICAL PROCEDURE, REHABILITATION PROCESS, PRECAUTIONS, AND RESIDUAL IMPAIRMENTS. THIS MANUSCRIPT LAYS THE FOUNDATION FOR WHICH STRENGTH AND CONDITIONING PROFESSIONS CAN IMPLEMENT A SAFE AND EFFECTIVE POST-REHABILITATION PROGRAM TO MAXIMIZE OUTCOMES WHILE MINIMIZING RISK.

Shoulder Joint and Muscle Characteristics Among Weight-training Participants with and without Impingement Syndrome.

Abstract Kolber, MJ, Hanney, WJ, Cheatham, SW, Salamh, PA, Masaracchio, M, and Liu, X. Shoulder joint and muscle characteristics among weight-training participants with and without impingement syndrome. J Strength Cond Res 31(4): 1024–1032, 2017—Subacromial impingement syndrome (SIS) has been reported as an etiological source of shoulder pain among weight-training (WT) participants; however, a paucity of evidence exists to describe intrinsic risk factors. The purpose of this study was to investigate specific risk-related joint and muscle adaptations among WT participants identified as having SIS based on a previously validated clinical testing cluster. Fifty-five men (mean age 27.3 years) who participated in recreational WT a minimum of 2 d·wk−1 were recruited, including 24 individuals with SIS and 31 without SIS serving as controls. Active range of motion (AROM), bodyweight-adjusted strength values, and strength ratios were compared between groups. Significant differences were present as WT participants with SIS had decreased internal and external rotation AROM (p ⩽ 0.016) and decreased bodyweight-adjusted strength values of the external rotator and lower trapezius musculature (p ⩽ 0.02) when compared with WT participants without SIS. Select strength ratios were greater in the SIS group (p ⩽ 0.004) implying agonist to antagonist muscle imbalances. The impaired joint and muscle characteristics identified among WT participants with SIS are not without consequence, as they are associated with shoulder disorders in both general and athletic populations. Practical applications for these findings may reside in exercise prescription that addresses internal rotation mobility, mitigates training bias, and favors muscles responsible for stabilization, such as the external rotators and lower trapezius. Strength and conditioning professionals should consider risk-related adaptations associated with WT when prescribing upper-extremity exercises.

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

Abstract Hanney, WJ, Kolber, MJ, Pabian, PS, Cheatham, SW, Schoenfeld, BJ, and Salamh, PA. Endurance times of the thoracolumbar musculature: Reference values for female recreational resistance training participants. J Strength Cond Res 30(2): 588–594, 2016—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.

The reliability, validity, and methodologic quality of measurements used to quantify posterior shoulder tightness: a systematic review of the literature with meta-analysis

HYPOTHESIS AND BACKGROUND Posterior shoulder tightness (PST) has been linked to numerous shoulder pathologies in both the general and athletic populations. Several methods for documenting PST have been described in the literature, which may lend to variability in clinical practice and research. The purpose of this study was to perform a systematic review with meta-analysis to investigate the reliability, validity, and methodologic quality of methods used to quantify PST. METHODS Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Data were extracted from the selected studies and underwent methodologic quality assessment and meta-analysis. RESULTS The search resulted in 1006 studies identified, with 18 ultimately retained. Intrarater reliability was reported in 12 studies with a summary intraclass correlation coefficient of 0.93 (95% confidence interval, 0.90-0.95), whereas inter-rater reliability was reported in 6 studies with a summary intraclass correlation coefficient of 0.89 (95% confidence interval, 0.80-0.94). Validity was reported in 10 studies, all using internal rotation as the convergent standard, and was found to be significant in all but 1 study. CONCLUSION Current methods used to quantify PST have good reliability but are primarily limited to measures of horizontal adduction of the glenohumeral joint with scapular stabilization. Limitations in using a single measurement technique exist particularly as there may be multiple contributing factors to PST. A more comprehensive approach for quantifying PST is necessary, and suggested components include a cluster of techniques composed of horizontal adduction, internal rotation, and total glenohumeral joint range of motion.