Scott W. Cheatham

Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence

CONTEXT Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation. OBJECTIVE To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint. EVIDENCE ACQUISITION A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews. EVIDENCE SYNTHESIS Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials. CONCLUSION This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

Concurrent Validity of Resting Pulse-Rate Measurements: A Comparison of 2 Smartphone Applications, the Polar H7 Belt Monitor, and a Pulse Oximeter With Bluetooth

CONTEXT Pulse rate is commonly measured manually or with commercial wrist or belt monitors. More recently, pulse-rate monitoring has become convenient with the use of mobile technology that allows monitoring through a smartphone camera. This optical technology offers many benefits, although the clinimetric properties have not been extensively studied. DESIGN Observational study of reliability Setting: University kinesiology laboratory. PARTICIPANTS 30 healthy, recreationally active adults. INTERVENTION Concurrent measurement of pulse rate using 2 smartphone applications (fingertip, face-scan,) with the Polar H7 belt and pulse oximeter. MAIN OUTCOME MEASURE Average resting pulse rate for 5 min in 3 positions (supine, sitting, and prone). RESULTS Concurrent validity in supine and standing was good between the 2 applications and the Polar H7 (intraclass correlation coefficient [ICC] .80-.98) and pulse oximeter (ICC .82-.98). For sitting, the validity was good between the fingertip application, Polar H7 (ICC .97), and pulse oximeter (ICC .97). The face-scan application had moderate validity with the Polar H7 (ICC .74) and pulse oximeter (ICC .69). The minimal detectable change (MDC90) between the fingertip application and Polar H7 ranged from 1.38 to 4.36 beats/min (BPM) and from 0.69 to 2.97 BPM for the pulse oximeter with both positions. The MDC90 between the face-scan application and Polar H7 ranged from 11.88 to 12.83 BPM and from 0.59 to 17.72 BPM for the pulse oximeter. The 95% limits of agreement suggest that the fingertip application may vary between 2.40 and 3.59 BPM with the Polar H7 and between 3.40 and 3.42 BPM with the pulse oximeter. The face-scan application may vary between 3.46 and 3.52 BPM with the Polar H7 and between 2.54 and 3.46 BPM with the pulse oximeter. CONCLUSION Pulse-rate measurements may be effective using a fingertip application, belt monitor, and pulse oximeter. The fingertip scanner showed superior results compared with the face scanner, which only demonstrated modest validity compared with the Polar H7 and pulse oximeter.

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 efficacy of wearable activity tracking technology as part of a weight loss program: a systematic review.

INTRODUCTION The world obesity rate has increased over the past two decades. This problem has been linked to inactivity and lack of exercise among individuals which prompted the development of wearable activity tracking technology. This technology is commonly offered as a bracelet, watch, or pendent that provides feedback of daily activity such as total step count, heart rate, and energy expenditure. Despite the popularity of these devices, their efficacy to assist in behavior change and weight loss is still being studied. The purpose of this systematic review was to appraise the current evidence on the efficacy of wearable activity devices when used in a comprehensive weigh loss program. EVIDENCE ACQUISITION A systematic review was conducted according the PRISMA guidelines. A search of electronic databases was conducted through December 2016 using the following keywords: activity monitor, consumer, wearable, technology, Fitbit®, Garmin®, Jawbone®, physical, activity, tracker, weight loss, walking, pedometer, accelerometer, step count, calories, obesity, digital, self-monitoring, and mobile health (mHealth). The grading of studies was conducted using the PEDro scale. EVIDENCE SYNTHESIS We identified 7184 citations, 25 met the inclusion criteria. Twenty-one studies scored a 6 or higher and four studies scored a 5 on the PEDro scale. All subjects had a Body Mass Index (BMI) of ≥25 kg/m2 and were mostly women. CONCLUSIONS The results suggests that short-term (<6 months) weight loss interventions using activity trackers may be a better option than a standard weight loss program in middle age or older adults. Younger adults may not benefit from such technology.

The clinical presentation of individuals with femoral acetabular impingement and labral tears: A narrative review of the evidence

Femoral acetabular impingement (FAI) has emerged as one of the more commonly recognized intraarticular hip pathologies and is often accompanied with a labral tear. The understanding of the clinical characteristics of individuals with symptomatic FAI has evolved over the past several years due to emerging research. As research progresses, there is often a gap in translating the current evidence to clinical practice. This manuscript presents the latest evidence underpinning the clinical presentation of FAI and labral tears. Evidence is presented within the context of bridging the latest research and clinical practice.

Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia

Abstract Background: Manual pressure palpation is an examination technique used in the classification of myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there are no validated systems for classifying results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this investigation was to validate a PPTS in individuals diagnosed with MPS and FM. Intra-rater reliability, concurrent validity, minimum cut-off value, and patient responses were evaluated. Methods: Eighty-four participants who met the inclusion criteria were placed into three groups of 28 (N = 84): MPS, FM, and asymptomatic controls. All participants underwent a two-part testing session using the American College of Rheumatology criteria for classifying FM. Part-1 consisted of manual palpation with a digital pressure sensor for pressure consistency and part 2 consisted of algometry. For each tender point (18 total), participants graded tenderness using the visual analog scale (VAS) while the examiner concurrently graded response using a five-point PPTS. Results: The PPTS had good intra-rater reliability (ICC ≥ .88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the digital pressure sensor and algometer (ρ ≥ .61). A minimum cut-off value of 2 on the PPTS differentiated participants with MPS and FM from asymptomatic controls. Discussion: The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions. Levels of Evidence: 2c. Clinical Trial Registration: ClinicalTrials.gov registration No. NCT02802202.

Comparison of a foam rolling session with active joint motion and without joint motion: A randomized controlled trial

BACKGROUND Foam rolling has become a popular form of self-myofascial release or roller massage among health and fitness professionals. Due to this popularity, foam roller devices can be found in many clinical and fitness settings. Despite the popularity, there are still several unknowns regarding foam rolling such the optimal technique. Specifically, there is a lack of research analyzing different foam roll techniques such as combining active joint motion with foam rolling. PURPOSE The purpose of this study was to compare the effects of a foam rolling session to the left quadriceps with active joint motion and without joint motion on passive knee flexion range of motion (ROM) and pressure pain thresholds (PPT). METHODS Thirty healthy adults were randomly allocated to one of two intervention groups: active joint motion and no joint motion. Each foam roll intervention to the left quadriceps lasted a total of 2 min. Dependent variables included passive knee flexion ROM and pressure pain threshold measures (PPT). Statistical analysis included subject demographic calculations and appropriate parametric and non-parametric tests to measure changes within and between intervention groups. RESULTS For left knee ROM, the active joint motion group demonstrated the greatest immediate increase in passive ROM (8°, p < .001) than the non-motion group (5°, p < .001). For PPT, the active joint motion group demonstrated the greatest immediate increase (180 kPa, p < .001) followed by the non-motion group (133 kPa, p < .001). Between group comparisons revealed a significance between groups for passive knee ROM (p < .001) and PPT (p < .001). CONCLUSION A short session of foam rolling with active joint motion appears to have a greater effect on passive joint ROM and PPT than rolling without motion. These observed changes may be influenced by the agonistic muscle activity during active motion. This activity may modulate activity of the antagonist muscle through reciprocal inhibition and other neural pathways. Future research is needed to confirm these findings.

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.

Hip Musculoskeletal Conditions and Associated Factors That Influence Squat Performance: A Systematic Review

CONTEXT The squat is a fundamental movement for weightlifting and sports performance. Both unilateral and bilateral squats are also used to assess transitional and dynamic lower-extremity control. Common lower-extremity conditions can have an influence on squat performance. Of interest are the effects of hip musculoskeletal conditions and associated factors, such as hip muscle pain, fatigue, and tightness, on squat performance. Currently, there has been no appraisal of the evidence regarding the association of these conditions and associated factors on squat performance. OBJECTIVE This study evaluated the current evidence regarding common hip musculoskeletal conditions and associated factors, such as hip muscle pain, fatigue, and tightness, on squat performance. EVIDENCE ACQUISITION A systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar® was conducted in October, 2016 using the following keywords alone and in combination: hip, joint, arthritis, pain, range of motion (ROM), fatigue, tightness, pathology, condition, muscle, intraarticular, extraarticular, femoroacetabular impingement, single leg, bilateral, squat, performance, and technique. The grading of studies was conducted using the Physiotherapy Evidence Database scale. EVIDENCE SYNTHESIS The authors identified 35 citations, 15 of which met the inclusion criteria. The qualifying studies yielded a total of 542 subjects (160 men and 382 women; mean age = 29.3 (5.9) y) and measured performance with either the barbell squat, step down, bilateral, or single-leg squat. Femoroacetabular impingement and hip arthroscopy were the only hip conditions found that affected the squat. Associated factors, such as muscle pain, fatigue, and tightness, also influenced squat performance. CONCLUSION This review found that common hip conditions and associated factors and their effects on squat performance to be underinvestigated. Future research should focus on the association between common hip conditions and squat performance.

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.