Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Improving Ankle Range Of Motion With The Use Of Instrument Assisted Soft Tissue Mobilization: A Validation Case Study, Sarah Jakubek, Elena Robinson, Annette D. Monk

Clinical Practice in Athletic Training

The purpose of this case validation study was to examine the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) on the ankle. The patient population consisted of nine participants (2 females, 7 males, age = 16± 2 years) from a suburban high school in Illinois. Each patient completed an IASTM treatment program, incorporating the Graston Technique (GT). The program was completed over a three-week period with 2 sessions occurring each week, for a total of 6 sessions. Data collection of ankle dorsiflexion range of motion (DFROM) occurred after the completion of the GT. This was assessed by performing the weight-bearing lunge …

Safety Of Blood Flow Restriction Training For Musculoskeletal Disorders: An Evidence-To-Practice Review, Breanna Ferguson, Erica Schulman, Matthew Zimmerman, Zachary K. Winkelmann

Clinical Practice in Athletic Training

Blood flow restriction training (BFRT) is low-level resistance training while partially occluding proximal blood flow. It is well documented that this style of training leads to increased muscle size as well as strength. It is theorized that these size and strength gains are due in part to the decreased oxygen environment. This results in increased muscular stress without the need for increased external load making this style of resistance training ideal for individuals who have restrictions due to musculoskeletal disorders. The guiding systematic review examined the safety of BFRT when used as a therapeutic intervention for patients with a variety …

Graston Technique® Combined With Therapeutic Intervention As An Alternative Treatment For A Grade Iii Ucl Thumb Sprain: A Disablement Model Case Study, Raul Anaya Jr., Kim Bacalla, Annette D. Monk

Clinical Practice in Athletic Training

Nonoperative measures have been shown to have positive effects on thumb ulnar collateral ligament (UCL) sprains considered less than complete. This case presents evidence supporting Graston Technique® (GT) plus therapeutic exercise in order to decrease pain and stiffness in a collegiate football athlete who sustained a grade III UCL sprain. The results showed that there was a reduction in pain level above the minimal clinically importance difference, and ROM improved throughout the three-week intervention. The findings of this case study provide minimal support for an alternative treatment to reduce pain and stiffness in a grade III UCL sprain, with further …

Using The Mulligan Mobilization With Movement And Fibular Repositioning To Treat High School Patients With A Grade One Lateral Ankle Sprain, Alexander Zettlemoyer, Rich Patterson, Russell Baker, Alan Nasypany

Clinical Practice in Athletic Training

Ankle injuries are common among high school athletics with the highest incidence rates in boys and girls basketball and boys football. Novel treatment paradigms like the Mulligan Mobilization with Movement (MWM) in conjunction with fibular repositioning tape have shown promising results in reducing pain, disability, and time lost due to lateral ankle sprains (LAS). However, research focusing on Mulligan treatment strategies and ankle swelling following a LAS is limited. Therefore, the purpose of this case series was to evaluate the combined effects of the MWM and fibular repositioning taping on swelling, function, and pain in high school patients with an …

Herpes Zoster As An Incidental Finding During Treatment For Thoracic Back Pain In A Collegiate Baseball Player, L E. Trail, B J. Warner, R L. Peebles, R M. Galbraith, C Cox, S A. Cage

Clinical Practice in Athletic Training

Background: A 21-year-old male collegiate baseball pitcher reported to the athletic training staff complaining of thoracic back pain when throwing during the non-traditional season. The patient did not recall a specific mechanism of injury, and noted that his pain had gradually increased over time. The patient reported no previous history of thoracic or lumbar spine injury. Further evaluation revealed multiple myofascial adhesions that did not resolve with conservative treatments. After the failure of conservative treatment, the patient was referred to the team physician for further evaluation.. Differential Diagnosis: Myofascial adhesions, Rib subluxation, Thoracic Disc Herniation Treatment: Upon referral, the team …

Best Practices For Clinical Evaluation Of Sacroiliac Joint Pain: An Evidence-To-Practice Review, Nicolette A. Harris, Adriana Peña, Sofia Núñez Rivera

Clinical Practice in Athletic Training

Sacroiliac joint (SIJ) pain serves as an under-recognized source of chronic low back pain. Improvement in the accuracy of a clinical SIJ pain diagnosis lends a higher likelihood of appropriate treatment measures, better patient outcomes and decreased out-of-pocket costs. Therefore, the overall purpose of this evidence to practice review was to highlight the main points of a systematic review on the clinical diagnosis of SIJ pain. Searches of five electronic databases revealed 758 studies, nonetheless only six studies met final inclusion criteria. Studies included were assessed by the authors for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies …

Opioid Medication Use And Education Following Sports Medicine Procedures: An Evidence-To-Practice Review, Caitlin S. O’Mara, Michael G. Ward, Zachary K. Winkelmann

Clinical Practice in Athletic Training

According to the Centers for Disease Control (CDC), illicit and prescription drug overdoses are responsible for 128 deaths every day in the United States. In 2018, 70% of all overdose related deaths involved opioids. Efforts to minimize the opioid epidemic focus on community education, research, partnership, and healthcare support. Under the CDC guidelines, current practices include monitoring trends of drug use and drug related deaths, conducting research to recognize areas in need of improvement and to analyze effectiveness of current treatments, partner with community organizations and healthcare systems that deal firsthand with opioid users, and educate the public on drug …

Disablement Model Case Study: Running With Postural Orthostatic Tachycardia Syndrome, Jordan Fenney, Wendy Reitz, Hayley M. Ericksen

Clinical Practice in Athletic Training

A 17-year-old high school female cross-country runner and basketball player presented with syncope following long-endurance exercise. The syncope episodes started when the patient was 13 years old during a basketball game. After the first episode, the patient fainted every time she crossed the finish line of a cross-country meet. Her symptoms included increased heart rate, shortness of breath, and paresthesia in her hands and legs during exercise. The patient also experienced some dizziness when quickly sitting or standing during activities of daily living. The patient was first misdiagnosed with exercise induced asthma and prescribed a rescue inhaler to take prior …

Effect Of Tissue Flossing On Grip Strength In Collegiate Baseball Players, M A. Eilers, B J. Warner, D M. Gallegos, I Hopper, S A. Cage

Clinical Practice in Athletic Training

Context: Tissue flossing bands are a relatively new therapeutic modality that has increased in popularity in recent years. While there is evidence to suggest that tissue flossing bands can decrease pain and increase perceived range of motion, there has been little research conducted to determine the effects of tissue flossing on muscular strength and performance. Thus, the aim of this study was to assess the effects of a single tissue flossing treatment on grip strength among healthy collegiate baseball players. Methods: Twenty apparently healthy collegiate baseball players (21.4 ± 1.54 years, 181.9 ± 3.56 cm, 84.5 ± 8.56 kg) were …

Nonsurgical Management Of Unilateral, Nondisplaced Lateral Malleolus Fracture In 17-Year-Old Outside Linebacker, K Tallman, R Bautista, B Spencer

Clinical Practice in Athletic Training

Background: Ankle fractures, specifically unilateral fractures, are among the most common injuries encountered by orthopedic surgeons. Ankle fractures have an incidence of 187 out of 100,000 individuals. Current treatment options for ankle fractures are dependent on stability of the ankle mortise, determined through number of fracture sites and ligamentous integrity. The management of the fracture scan either be surgical or nonsurgical, the majority being surgical. In this case report, a 17-year-oldmaleoutside linebacker sustained a left lateral ankle injury during a regular season football game. As he attempted to make a tackle, his left foot got caught in the turf, he …

Bi-Lateral Hand Compartment Syndrome Secondary To Autoimmune Disorder In A Former High School Multi-Sport Athlete, Alyssa Vaniman

Clinical Practice in Athletic Training

Patient is a 21-year-old female former multiple-sport athlete who has suffered from the development of multiple cases of compartment syndrome throughout their body. At the time the medical staff encountered the patient, they were diagnosed with bilateral hand compartment syndrome. An autoimmune disorder known as Scleromyositis was diagnosed as the source of the multiple diagnosed cases of compartment syndrome. Prior to surgical intervention, the patient was unable to complete everyday tasks as a student. As pressure within their hypothenar, thenar, and interosseous compartments grew, the patient was no longer able to complete everyday fine motor skill tasks. A post-surgical rehabilitation …

The Presentation Of Adhesive Capsulitis Of The Hip: A Case Study, Patrick E. Jurewicz, Ryan C. Berlinrut, Frank K. Noojin Iii, Zachary K. Winkelmann

Clinical Practice in Athletic Training

A 47-year-old female patient employed as a nurse in a mental health facility working 10-hour shifts reported to the sports medicine clinic for an initial orthopaedic examination after she twisted and fell out of bed causing direct compressive forces on her right hip. She has a history of an underdeveloped right hip, a non-steroidal anti-inflammatory drug (NSAID) allergy, and low back pain (Oswestry score: 41/50, NPRS: 8/10) and is classified as a heavy smoker for 30 years. After initial onset, the patient’s pain increased with all motions. The patient also described a ‘catching sensation’ in her hip. The patient used …

Community Opioid Overdose Prevention And Naloxone Distribution Programs: An Evidence-To-Practice Review, Madison M. Hauge, Kathryn C. Downs, Zachary K. Winkelmann

Clinical Practice in Athletic Training

According to the Centers for Disease Control and Prevention, 100 people die of drug overdose in the United States every day. This frighteningly high mortality rate has created the need for community-based opioid overdose prevention programs (OOPPs). Currently, there are more than 188 community-run programs operating in the United States. These programs teach individuals how to distribute naloxone and respond properly to a drug overdose situation. This guiding systematic review depicts the current literature available on OOPPs and their effectiveness. The authors performed an article search to discover the most relevant and recent articles, which were graded using a quality …

The Role And Value Of The Athletic Trainer In The Chiropractic Medicine Setting, Nicholas Spangler

Clinical Practice in Athletic Training

In the United States, back pain is the most common cause of activity limitation in people younger than 45 years, the second most frequent reason for visits to the physician, the third most common cause of surgical procedure, and the most frequently reported subcategory of musculoskeletal impairment in the United States of people aged up to 65 years (51.7%).1 Chiropractors are healthcare professionals who are trained in the evaluation and treatment of this patient population and utilize a variety of skills like spinal manipulation, soft tissue mobilization, modalities, and therapeutic exercise. Athletic trainers are healthcare professionals whose educational and clinical …

Evaluation And Treatment Of The Water-Polo Player With Anterior Glenohumeral Instability, M Zimmerman

Clinical Practice in Athletic Training

Background: Glenohumeral (GH) instability is a common shoulder condition with a range of characteristics from laxity within the GH joint to complete dislocation of the humerus. The GH joint is held in place by static and dynamic stabilizers that need to be functioning appropriately to center the humerus in the glenoid fossa. Acquired shoulder instability is defined as chronic stress of the humerus in an externally rotated and abducted position on the shoulder joint from repetitive overhead (OH) sports causing anterior instability of the shoulder. Diagnosing shoulder instability is reliant on the patient’s history and physical examination findings during testing. …

Cervical Kyphosis In A Collegiate Baseball Player, L E. Trail, B J. Warner, D M. Gallegos

Clinical Practice in Athletic Training

Background: A 21-year-old collegiate baseball player reported to the athletic training staff complaining of pain along the superior angle of the scapula, decreased shoulder range of motion, and transient numbness and tingling in the 4th and 5th digits of his right hand. Physical evaluation revealed substantial spasm and rigidity of the upper trapezius and scapular stabilizer musculature, along with myofascial adhesions in the rhomboids and levator scapulae, in addition to weakness with shoulder abduction and external rotation. All thoracic outlet syndrome testing yielded no positive tests. Thorough patient history revealed a history of shoulder arthroscopy the previous summer to address …

An Exploratory Analysis Of A Treatment Based Classification Algorithm To Treat Patellar Tendinopathy, Monica Matocha, Patti Syvertson, Janet Mcmurray, Emily R. Dietz, Russell T. Baker, Alan Nasypany, Don Reordan, Darcy Downey

Clinical Practice in Athletic Training

The general and athletic populations commonly experience patellar tendon pain, which is frequently treated with a gold standard 12-week eccentric exercise protocol. The present research study was designed to determine the effects of a treatment based classification (TBC) algorithm utilizing indirect treatment techniques in patellar tendinopathy participants. Ten participants (seven females, three males, mean age = 19.6 ± 1.07, mean symptom duration = 2.14 years with a range of one week to six years) with patellar tendinopathy were evaluated and included in this study. Each participant underwent a thorough evaluation process to aid in determining inclusion: participant medical history, range …

Effectiveness Of Take-Home Naloxone Programs In Athletic Training: An Evidence-To-Practice Review, Michael J. Palm, Amanda N. Flanscha, Zachary K. Winkelmann

Clinical Practice in Athletic Training

The number of opioid overdoses (ODs) has risen in recent years and has become more complex due to the co-involvement of both prescription and illicit opioid drug use. Provisional programs for take-home naloxone (a medication designed to rapidly reverse opiate OD symptoms) kits have been distributed to combat this potentially fatal epidemic. Although there is strong evidence to support the efficacy of naloxone in the reversal of opiate OD, there is limited evidence to support the efficacy of take-home naloxone (THN) kits. The purpose of this evidence-to-practice review was to summarize a systematic review on the efficacy of THN programs. …

Diagnosis And Intervention Of Posterior Shoulder Impingement In A Non-Throwing Athlete, K Orrick

Clinical Practice in Athletic Training

Background: Posterior impingement, also commonly called internal impingement, is identified by a repetitive compression of the posterosuperior aspect of the glenoid by the greater tuberosity of the humeral head when the arm is in an abducted and externally rotated position. There are multiple possible causes of this impingement. One of the most frequent contributors is scapular dyskinesis, where the scapula does not track properly with overhead movement due to weakness. Other contributors include kinetic chain instabilities found in the spine, core, and lower extremity, as well as glenohumeral instability causing a shift in the humeral head. Posterior impingement is commonly …

Treatment And Management Of Complex Knee Injury: A Case Report, K Braunreiter, S Kerwin

Clinical Practice in Athletic Training

Background: The “unhappy triad” injury includes tears of the anterior cruciate ligament, medial collateral ligament, and medial meniscus. There is limited research on the prevalence and outcome of this injury. The unique surgical repair consisting of lateral extra-articular tenodesis (LET) was utilized to reinforce the anterior cruciate ligament repair (ACLR) and to prevent rerupture. Due to this extensive surgery, the patient struggled to regain full range of motion and quadriceps activation. This case is a Level 2 case study that explores the different interventions used to address the aforementioned objective deficits and return him safely to play. Patient: The patient …

A Proposed Return-To-Ride Protocol For United States Jockeys Following Concussion, Carolina Quintana, Kimberly I. Tumlin, Matthew C. Hoch, Nicholas R. Heebner, Bianca L. Grimshaw, Carl G. Mattacola

Clinical Practice in Athletic Training

Professional horse racing jockeys participate in a high-risk sport, however there is limited research and policies regarding welfare and safety. Despite the high incidence and risk of concussions, there are not standardized protocols for returning these unique athletes to participation following concussion. A return-to-ride concussion protocol for thoroughbred horse racing athletes must take into account the unique considerations and practices of the sport. Current concussion management strategies suggest removal from riding and activity when a concussion is suspected. This is followed by further evaluation for diagnosis, a period of both cognitive and physical rest before a gradual return-to-activity prior to …

Rest And Therapeutic Interventions Following Sport-Related Concussion: An Evidence-To-Practice Review, Alyssa L. Bolno, Brittni G. Hoover, Ryan J. Michels, Allison B. Smith, Zachary K. Winkelmann

Clinical Practice in Athletic Training

Sport-related concussion (SRC) is among the most common injuries seen in both sports and recreation, especially collision and full contact sports. However, there has been controversy surrounding which recovery protocol would be best used in the rehabilitation of a person who has suffered from SRC. Symptoms and dysfunctions can vary from patient to patient. The average recovery time for adults is 14 days post incidence. Although most patients recover over the first few days/weeks post-injury, 15% reported recovery time of 30 or more days. Previous research determined a need for cognitive and physical rest of 24-48 hours, or until acute …

The Usefulness Of The Left Atrial Dilation Rate In Determining Severity Of Heart Failure, Laura B. Snyder

Senior Theses

Hypertension and vascular stiffness are two physiological conditions that strain the left ventricle (LV) and cause it to gain muscle mass. Eventually, the LV is unable to fill correctly and the patient develops Heart Failure with a preserved Ejection Fraction (HFpEF). Clinically, a patient’s left atrium (LA) area is measured as a diagnostic parameter of HFpEF severity. However, this doesn’t offer a prognosis or threshold of LA size necessitating hospitalization because of variation in patient demographics, genetics, and lifestyle which affect rates of HFpEF progression.

Since there are no medications or effective treatment options for HFpEF patients, there is a …

Point-Of-Care Research: Retrospective Analysis Of The Evaluation And Classification Of Tendon Pathology In Athletic Training, Ashley J. Reeves, Russell T. Baker, Scott W. Cheatham, Alan Nasypany

Clinical Practice in Athletic Training

Tendon pathology has been studied across healthcare professions but remains poorly understood. Imaging and clinical findings have been used to diagnose tendon pathology, but these findings are discrepant. It is vital that clinicians use sound clinical judgment to determine the most accurate clinical diagnosis and treatment options given documented clinical findings. The purposes of this study were to assess athletic trainers’: 1) documented clinical findings for patients presenting with tendon pain, 2) use of documented findings to inform clinical diagnosis of tendon pathology, and 3) change in tendon pathology classification when presented with a novel diagnostic term. A total of …

Functional Balance Assessment Of Firefighters During Mass-Screening Examinations, Rachel M. Eiler, Zachary K. Winkelmann, Kenneth E. Games

Clinical Practice in Athletic Training

Firefighters are tactical athletes who are required to complete rigorous tasks as part of their job functions. The focus of this clinical outcomes assessment was to assess functional balance assessment through the use of the anterior reach test with and without personal protective equipment (PPE) during a mass-screening examination. The screening was completed with 61 active firefighters in a local fire department with access to athletic training services. The results of the anterior reach assessment identified a significant difference of a firefighter’s anterior reach when donning and doffing PPE. Anterior reach distances were significantly reduced (P < 0.001) on the right leg with (mean = 55.78 cm ± 7.53 cm) and without PPE (mean = 58.92 cm ± 6.47 cm). Similarly, significant decrements (P = 0.003) in left leg anterior reach distance in firefighters donning (mean = 57.67 cm ± 8.25 cm) and doffing (mean = 59.82 cm ± 6.31 cm) PPE. Clinical application of these findings suggests that healthcare providers working with tactical athletes, specifically firefighters, should consider the risks associated with donning PPE such as functional balance deficits.

Deep Vein Thrombosis In Lower Extremity Of A Female Collegiate Volleyball Athlete: A Case Study, Lucas D. Dargo, Kendra Borton, Rachel Roths, Zachary Dougal

Clinical Practice in Athletic Training

Deep vein thrombosis (DVT) occurs when a blood clot forms in deep veins in the body, usually in the lower extremity. DVT is commonly seen in older or hospitalized patients. This case is unique because the patient is a 20-year-old female division III collegiate volleyball athlete, which is not the typical age or population affected by DVT or clotting disorders. The patient presented with swelling, pain, and decreased knee flexion (3/5) and plantarflexion (4/5) strength in her left lower extremity. These impairments reduced her ability to walk or run. The patient’s athletic trainer (AT) initially diagnosed her with a left …

Posterior Glenoid Dysplasia As A Secondary Finding To Labrum Tear And Subscapularis Strain: A Case Study, S. Andrew Cage, Brandon J. Warner, Diana M. Gallegos

Clinical Practice in Athletic Training

The purpose of this disablement model case study was to describe the case of a collegiate baseball pitcher suffering from a labral lesion and supraspinatus strain that may have been the result of posterior glenoid dysplasia. Despite gross instability and glenohumeral external rotation weakness, the patient was initially able to continue to pitch. While posterior glenoid dysplasia has been described in literature, there have not been studies that have evaluated soft tissue changes that may be associated with this bony morphology abnormality. In this case, the patient reported to the athletic training staff complaining of pain, tightness, and a “clunking” …

The Effects Of The Myokinesthetic System On Medial Tibial Stress Syndrome In The Physically Active: A Case Study, Rodrigo E. Martinez, Evelyn Benitez-Lopez, Lindsey Larkins

Clinical Practice in Athletic Training

Medial tibial stress syndrome (MTSS) is a common pathology in physically active people and one of many overuse leg injuries present in weight bearing athletes, with the highest prevalence in runners. Researchers have extensively explored treatment for MTSS, but a long-lasting and effective treatment option has not been established. This case report aimed to explore the effects of The MyoKinesthetic SystemTM (MYK), a form of manual therapy, on two athletes diagnosed with MTSS. Patient one is a 19-year-old male rugby player with a previous history of MTSS, who reported leg pain while running which progressed to constant pain. Patient two …

Diagnostic Accuracy Of Imaging Techniques For Rotator Cuff Pathology: An Evidence-To-Practice Review, Hayley O’Connell, Brittany Decamp, Zachary Winkelmann

Clinical Practice in Athletic Training

When comparing imaging techniques for rotator cuff pathologies, clinicians tend to consider musculoskeletal ultrasonography (MSK US), magnetic renaissance imaging (MRI), and magnetic renaissance imaging with arthrogram (MRA) as diagnostic imaging techniques. Since the most recent systematic review on imaging conducted in 2003, imaging technology has improved, indicating the need for a meta-analysis to evaluate the accuracy of new diagnostic techniques (MSK US) for evaluating rotator cuff pathologies. The accuracy of MSK US readings between radiologists and non-radiologists was also analyzed. Data were extracted from three different databases and included articles exploring diagnostic imaging and the accuracy of technique at the …

Myofascial Compression Interventions: Comparison Of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, And Floss Band On Passive Knee Motion Among Inexperienced Individuals, Scott W. Cheatham, Rodrigo E. Martinez, Alicia Montalvo, Michelle Odai, Stephanie Echeverry, Brianna Robinson, Elizabeth Bailum, Kevin Viecco, Kasey Keller, Sofia Nunez-Riveria, Adriana Pena

Clinical Practice in Athletic Training

Myofascial compression interventions have become popular in rehabilitation and fitness. To date, no studies have directly compared foam rolling, instrument assisted soft-tissue mobilization, and floss band among unexperienced individuals. The primary purpose of this investigation was to compare the immediate post intervention effects of foam rolling, instrument assisted soft-tissue mobilization, and floss band on passive knee joint range of motion (ROM) among inexperienced individuals using a standard treatment time. The secondary purpose was to determine the interchangeability of the interventions and to provide preliminary research for long-term comparison studies. This pretest-posttest randomized controlled trial was conducted in a university laboratory. …