Steven R. Passmore

Head–Putter Coordination Patterns in Expert and Less Skilled Golfers

The authors examined the patterns of expert and less skilled golfers in putting on an indoor surface to 1 of 3 circular targets (1, 3, and 5 m away) in trials with a ball present (and putted) or not present (a practice stroke). As expected, the experts performed better than the less skilled golfers on a large number of outcome and kinematic measures. Displacement and velocity profiles of the head and putter revealed high positive correlations for the less skilled golfers, indicating a dominant allocentric coordination pattern, but high negative correlations for the expert golfers, indicating a dominant egocentric coordination pattern. The observed coordination patterns did not interact with the distance of the intended putt or the presence/absence of a ball. These findings offer preliminary evidence that, although contrary to traditional beliefs, fundamental differences exist in putting coordination modes between expert and less skilled golfers.

Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis.

Study Design. A cross-sectional study. Objective. To identify the relationship between performance measures derived from accelerometry and subjective reports of pain, disability, and health in patients with lumbar spinal stenosis (LSS). Summary of Background Data. Accelerometers have emerged as a measure of performance, providing the ability to characterize the pattern and magnitude of real-life activity, and sedentarism. Pain and loss of function, particularly ambulation, are common in LSS. The extent to which pain, perceived disability, and self-rated health relate to performance in patients with LSS is not well known. Methods. Data regarding self-reported pain, disability (Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Disabilities of the Arm, Shoulder, and Hand), and health (36-Item Short Form Health Survey [SF-36]) were collected from patients with LSS (n = 33). Physical activity, ambulation, and inactivity performance measures were derived from 7-day accelerometer records. Correlation and stepwise regression were used. Results. The physical function subscale of the SF-36, a non–pathology-specific outcome, had the best overall correlation to physical activity and ambulation (average r = 0.53) compared with pain (average r = 0.32) and disability (average r = −0.45) outcomes. Stepwise regression models for performance were predominantly single-variable models (4 of 8 models); pain was not selected as a predictor. A second non–pathology-specific outcome, the Disabilities of Arm Shoulder and Hand, improved the prediction of performance in 5 of 8 models. Conclusion. Subjective measures of pain and disability had limited ability to account for real-life performance in patients with LSS. Future research is required to identify determinants of performance in patients with LSS because barriers to activity may not be disease-specific.

The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline

OBJECTIVE The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. METHODS Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. RESULTS For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioners advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). CONCLUSIONS A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.

Performance based objective outcome measures and spinal manipulation

This paper provides a general overview of performance based outcome measures used in an attempt to objectively measure the ramifications of spinal manipulation. While not a systematic or exhaustive review it serves to categorize, and provide insight into the background, successes and shortcomings of measurement techniques used. The outcome measures are drawn from the full spectrum of approaches to research and are broken down into the following sections: (1) biomechanically constrained motor performance measures, (2) neurologically constrained performance measures and (3) perceptual, perceptual motor, and complex task constrained performance measures. The paper concludes with some future research directions to enhance the understanding of the impact of spinal manipulation, and how to objectively measure its mechanical and physiological effects on the human system.

Anatomically remote muscle contraction facilitates patellar tendon reflex reinforcement while mental activity does not: a within-participants experimental trial.

BackgroundThe Jendrassik maneuver (JM) is a remote facilitation muscular contraction shown to affect amplitude and temporal components of the human stretch reflex. Conflicting theoretical models exist regarding the neurological mechanism related to its ability to reinforce reflex parameters. One mechanism involves the gamma motoneurons of the fusimotor system, which are subject to both physical and mental activity. A second mechanism describes reduced alpha motoneuron presynaptic inhibition, which is not subject to mental activity. In the current study, we determined if mental activity could be used to create a reflex facilitation comparable to a remote muscle contraction.MethodUsing a within-participants design, we investigated the relative effect of the JM and a successfully employed mental task (Stroop task) on the amplitude and temporal components of the patellar tendon reflex.ResultsWe found that the addition of mental activity had no influence on the patellar tendon reflex parameters measured, while the JM provided facilitation (increased reflex amplitude, decreased total reflex time).ConclusionThe findings from this study support the view that the mechanism for the JM is a reduction in presynaptic inhibition of alpha motoneurons as it is influenced by physical and not mental activity.

Do Expert Golfers Keep Their Heads Still While Putting

The putting patterns of five expert and 11 less-skilled golfers were examined to understand the nature of head movement that occurred during the putting stroke. As expected, the less-skilled golfers moved their heads in the direction of the backswing, then reversed and moved it in the direction of the downstroke during the putt. In contrast, and contrary to expectations, the experts did the reverse – they moved their head in a direction that was opposite to the direction of the putter. The strokes of both the experts and less-skilled golfers revealed closely matched timing constraints, indicating a strong preference to organize these actions as a single coordination pattern

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative

Objective: The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments. Methods: The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8‐member multidisciplinary external committee. Results: For patients with acute (0–3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self‐management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back‐related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises). Conclusions: A multimodal approach including SMT, other commonly used active interventions, self‐management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.

Research priorities of the Canadian chiropractic profession: a consensus study using a modified Delphi technique

BackgroundResearch funds are limited and a healthcare profession that supports research activity should establish research priority areas. The study objective was to identify research priority areas for the Canadian chiropractic profession, and for stakeholders in the chiropractic profession to rank these in order of importance.MethodsWe conducted a modified Delphi consensus study between August 2015 and May 2017 to determine the views of Canadian chiropractic organisations (e.g. Canadian Chiropractic Association; provincial associations) and stakeholder groups (e.g. chiropractic educational institutions; researchers). Participants completed three online Delphi survey rounds. In Round 1, participants suggested research areas within four broad research themes: 1) Basic science; 2) Clinical; 3) Health services; and 4) Population health. In Round 2, researchers created sub-themes by categorising the areas suggested in Round 1, and participants judged the importance of the research sub-themes. We defined consensus as at least 70% of participants agreeing that a research area was “essential” or “very important”. In Round 3, results from Round 2 were presented to the participants to re-evaluate the importance of sub-themes. Finally, participants completed an online pairwise ranking activity to determine the rank order of the list of important research sub-themes.ResultsFifty-seven participants, of 85 people invited, completed Round 1 (response rate 67%). Fifty-six participants completed Round 2, 55 completed Round 3, and 53 completed the ranking activity. After three Delphi rounds and the pairwise ranking activity was completed, the ranked list of research sub-themes considered important were: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services; 4) Effects of chiropractic care; 5) Safety/side effects of chiropractic care; 6) Chiropractic care for older adults; 7) Neurophysiological mechanisms and effects of spinal manipulative therapy; 8) General mechanisms and effects of spinal manipulative therapy.ConclusionsThis project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.

Fitts’s Law using lower extremity movement: Performance driven outcomes for degenerative lumbar spinal stenosis

A paucity of objective outcome measures exists for assessing movement disorders, including degenerative lumbar spinal stenosis (LSS). Fittss Law provides a novel approach to clinical outcome measurement since performance is resistant to learning, and task difficulty can be altered. The objective of the present study was to compare, using a Fittss task, movement performance of individuals with and without LSS to determine if motor difficulties that arise with LSS impede the planning, initiation, or execution of deliberate lower limb movements. Twelve pre-surgical LSS patients and twelve control participants from the community performed a Fittss Law (foot reaching) task, while LSS participants also completed pain and disability questionnaires. Fittss Law was evident for both groups, however the LSS groups movements were more adversely impacted as task difficulty increased. Specifically, the LSS groups movement time and time to peak velocity (ttPV) increased as task index of difficulty increased, while peak velocity decreased. Correlations between ttPV and leg pain, and with stenosis impairment severity respectively, provided evidence that less support leg pain and less stenosis impairment severity yield faster ttPV in the moving leg at the highest index of difficulty. Therefore a lower extremity Fittss Law task captured differences in the planning and execution of leg movements between healthy and LSS populations.

Acceleration of clinician hand movements during spinal manipulative therapy

This study used an observational design to examine the kinematics of spinal manipulative therapy (SMT) by determining the acceleration characteristics of the manipulative input at the cervical, thoracic, and lumbar spinal regions. Studies of SMT have been restricted to measuring the forces that result from the manipulative input. Several studies have indicated the rate of force development is a key parameter of clinically delivered SMT. Despite this, the movement strategies employed during SMT, including acceleration, have not been directly measured. Participants (n = 29) were recruited from a private practice chiropractic clinic. A wireless accelerometer attached to the clinicians hand was used to characterize the thrust phase of the SMT treatments. Significant differences were found across each spinal region for acceleration amplitude parameters (p < 0.0001). Post-hoc analysis indicated that amplitudes significantly increased in order from thoracic to cervical to lumbar regions (p < 0.0001). Spinal level was also a significant factor in determining the temporal parameters of hand acceleration during SMT (p < 0.0005). This study provides a description of the acceleration properties of clinically delivered SMT. Consistent with that reported for SMT forces, acceleration amplitudes varied significantly across spinal regions with relatively little differences in acceleration latencies. Notably, acceleration amplitudes and latencies were not associated with each other within spinal regions. These findings indicate that changes in acceleration amplitude, rather than latency, are used to tailor SMT to individuals.