Orthopaedic Section Abstracts: Poster Presentations ......Poster Presentations OPO1-OPO243 The...

C o m b i n e d S e c t i o n s M e e t i n g

a58 | january 2017 | volume 47 | number 1 | journal of orthopaedic & sports physical therapy


UE grip/pinch strength and axial loading tolerance in all limbs.DISCUSSION: Prior literature suggests that SD can lead to decreased pain in treated limbs; however, changes in untreated painful areas have not been documented. After 10 weeks of SD, this spinal cord injured patient showed notable reductions in pain intensity, distribution, and allodynia in both treated and untreated limbs. Somatosensation in proximal, nonpain-ful areas normalized as pain decreased in more distal areas. These find-ings suggest central neuroplastic changes may occur from SD treatment, perhaps involving normalization of representation of affected and unaf-fected areas in the neuromatrix.REFERENCES: Freedman M, Greis A, Marino L, Sinha A, Henstenburg J. Complex regional pain syndrome: diagnosis and treatment. Phys Med Rehabil Clin N Am. 2014;25:291-303. Barnhoorn KJ, Oostendorp RA, van Dongen RT, et al. The effectiveness and cost evaluation of pain ex-posure physical therapy and conventional therapy in patients with com-plex regional pain syndrome type 1. Rationale and design of a random-ized controlled trial. BMC Musculoskelet Disord. 2012;13:58. Allen RJ, Soterakopoulos C, Fugere KJ, et al. Pain distribution quantification using enhanced ‘rule-of-nines’: reliability and correlations with intensity, sen-sory, affective, and functional pain measures. Physiother. 2011;97:309. Allen R. Multimodal allodynia treated with somatosensory specific de-sensitization in patients with complex regional pain syndrome. Eur J Pain. 2009;13:144-145. Allen R. Physical agents used in the manage-ment of chronic pain by physical therapists. Phys Med Rehabil Clin N Am. 2006;17:315-345. Taub E, Uswatte G, Mark VW, Morris DM. The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys. 2006;42:241-256.

OPO2MANUAL THERAPY INTERVENTIONS FOR ADOLESCENT TO COLLEGIATE-AGED INDIVIDUALS WITH POSTCONCUSSION DISORDER: A RAPID REVIEWJordan E. Allison, Chris A. SebelskiDepartment of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri; SLU-SSM Physical Therapy Orthopedic Residency, St Louis, MissouriPURPOSE/HYPOTHESIS: The purpose of this rapid review was to examine current literature related to manual therapy interventions for adolescent to collegiate-aged individuals with postconcussion disorder (PCD) with persistent headache, neck pain, or dizziness.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: Eligible studies included randomized-controlled

Orthopaedic Section Abstracts: Poster Presentations

OPO1-OPO243The abstracts below are presented as prepared by the authors.

The accuracy and content of each abstract remain the responsibility of the authors. In the identification number above each abstract,

OPO designates an Orthopaedic Section poster presentation.

OPO1EFFECTS OF DESENSITIZATION ON PAIN DISTRIBUTION AND NORMALIZATION OF SOMATOSENSATION IN A PATIENT WITH QUADRILATERAL COMPLEX REGIONAL PAIN SYNDROMERoger J. Allen, Lisa J. Cook, Dullen R. Kristen, Jacob N. Hoffman, Megan A. VentoPhysical Therapy, University of Puget Sound, Tacoma, WashingtonBACKGROUND AND PURPOSE: Complex regional pain syndrome (CRPS) is a chronic condition affecting 1 or more extremities that can develop after injury, involving constant limb pain, allodynia, and hyperpathic autonom-ic and somatic symptoms. Somatosensory desensitization (SD) has long been considered essential in CRPS treatment, yet efficacy evidence re-mains limited. This study’s aim was to assess pain intensity and distribu-tion differences between treated and untreated limbs, as well as potential somatosensory normalization of proximal nonpainful limb regions, fol-lowing 10 weeks of SD in a patient with quadrilateral CRPS.CASE DESCRIPTION: The patient was a 54-year-old male with incomplete C5 SCI. Eighteen months of physical therapy yielded nearly full func-tional unassisted mobility, yet constant searing pain and tactile allodyn-ia developed in all extremities. Prior to seeking SD therapy, the patient experienced constant pain for 5 years following type II CRPS diagnosis. Quadrilateral involvement afforded an opportunity to desensitize 1 up-per and 1 lower limb, allowing outcome assessment of treated and un-treated limbs. During a 10-week treatment, the patient was exposed to progressively coarser materials via self-massage BID with weekly stimu-lus progression. Pain body diagrams (PBD) were completed pre and post SD and at 7-month follow-up. Changes in limb pain extent were quan-tified with pain distribution score (PDS) calculations applied to PBDs. Outcome measures taken weekly and at the 7-month follow-up on each limb included visual analog pain scale (VAS) and allodynia assessments via algometry. Semmes Weinstein monofilaments and 2-point discrimi-nation were used to assess somatosensory changes to affected and unaf-fected limb areas.OUTCOMES: Overall PDS decreased by 23.5%, with reductions of 9.5% for treated and 14.0% for untreated limbs. VAS scores for the treated limbs decreased by 5.5 cm UE and 2.4 cm LE, with reductions of 0.3 cm and 1.2 cm for the untreated UE and LE, respectively. Monofilament and 2-point discrimination testing revealed pretreatment subnormal somatosenso-ry thresholds and acuity of proximal nonpainful limb areas, that subse-quently normalized with corresponding reductions in distal pain. Other posttreatment changes included reduced allodynia and improvements in

47-01 CSM Ortho Posters.indd 58 12/22/16 5:20 AM

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journal of orthopaedic & sports physical therapy | volume 47 | number 1 | january 2017 | a59


trials, meta-analyses, prospective and retrospective comparative co-hort studies, case series, and case reports examining the use of man-ual therapy for treatment in adolescent to collegiate-aged individu-als with PCD. Standardized search terms were used to search PubMed, Scopus, CINAHL Plus with full text, SPORTDiscus with full text and the Cochrane Library. Grey literature included conference, symposium and website data from the American Academy of Orthopaedic Manual Physical Therapists, the North American Institute of Orthopedic Manual Therapy and the Maitland-Australian Physiotherapy Seminars. Inclusion criteria: literature published from 2006 to present, incorporation of man-ual therapy as defined by the American Physical Therapy Association and participants 13 to 26 years old. Exclusion criteria: studies specific to acute concussion management and those not including manual thera-py interventions. Study level of evidence was assessed using criteria from the Centre for Evidence-Based Medicine, for prospective and therapeu-tic studies.RESULTS: Three hundred eighty-three studies were retrieved. After dupli-cates removed, 260 titles/abstracts were reviewed and 30 full-text arti-cles were assessed for eligibility. Five of the 30 studies were eligible, and assessed for level of evidence. Four of the studies were case studies/series (level 4 evidence) and 1 was a randomized controlled trial, (level 1b evi-dence). One of 5 studies evaluated the effects of manual therapy interven-tion in isolation, whereas the remaining 4 studies utilized a multimod-al approach including manual therapy. Based on this rapid review, these studies concluded that integration of manual therapy for management of individuals with PCD improves neck pain, dizziness, and headache, and facilitates a quicker return to athletic competition.CONCLUSIONS: This rapid review included 5 studies of individuals with PCD and the associated symptoms of neck pain, headache and dizziness. A multimodal approach, including manual therapy interventions, is an ef-fective way to decrease neck pain, headache and/or dizziness associated with PCD. There is a paucity of literature available at this time specific to manual therapy interventions for those with PCD.CLINICAL RELEVANCE: Based on the limited evidence available, manual ther-apy interventions are a safe and effective mode of treatment for individu-als suffering from PCD. Further investigation is required to validate this conclusion.

OPO3CROSS-CULTURAL ADAPTATION AND PSYCHOMETRIC PROPERTIES TESTING OF THE ARABIC ANTERIOR KNEE PAIN SCALEAbdullah AlshehriLoma Linda University, Riyadh, Saudi ArabiaPURPOSE/HYPOTHESIS: The purpose of this study was to translate, develop a cross-cultural adaptation, and examine validity, test-retest reliability and feasibility of the Arabic version of the Anterior Knee Pain Scale (AKPS) in patients with Patellofemoral Pain Syndrome (PFPS).NUMBER OF SUBJECTS: Forty subjects with age ranging from 18 to 50 years.MATERIALS/METHODS: We followed international recommendations to per-form a cross-cultural adaptation of the AKPS. The measurements test-ed were reliability, validity, and feasibility. The cross-cultural adaptation was conducted in 2 major stages: translation and cross-cultural adapta-tion and assessment of psychometric properties. The first stage was per-formed according to the guidelines published for the translation and cross-cultural adaptations of health-related questionnaires and adopted by the American Orthopaedic Surgeons Association (AOSA). The second stage employed the use of quality criteria for assessing properties of the questionnaire; this included (1) translation, (2) synthesis, (3) back-trans-lation, (4) expert committee review, (5) pretesting, and (6) validation. The Arabic AKPS and the Arabic RAND 36-item Health Survey were admin-istered to 40 patients who were diagnosed with PFPS. Participants were assessed at baseline for both scales and after 2 to 3 days, assessed with the Arabic AKPS only.RESULTS: The Arabic AKPS showed high reliability for temporal stabili-

ty, internal consistency (Cronbach’s alpha was .81 for the first assessment and 0.75 for the second), excellent test-retest reliability (intraclass cor-relation coefficients [ICC] = 0.96; 95% confidence interval [CI]: 0.93, 0.98) and good agreement (standard error of measurement [SEM], 1.8%). The Arabic AKPS was significantly correlated with physical com-ponents of the RAND 36-Item Health Survey (Spearman’s rho = 0.69: P<.001). No ceiling or floor effects were observed.CONCLUSIONS: The Arabic AKPS is sufficiently reliable, valid, and appro-priate for use as a patient reported outcome measure for Arabic speaking individuals with patellofemoral pain syndrome.CLINICAL RELEVANCE: The Arabic version of the AKPS can be used as a sub-jective and functional assessment tool for Arabic-speaking individuals with patellofemoral pain syndrome in daily clinical practice and in re-search studies.

OPO4DIFFERENTIAL DIAGNOSIS IN A PATIENT REFERRED TO PHYSICAL THERAPY FOR KNEE PAINRocio Antone, Eric Reyes, Elizabeth LemosQuentin Mease Hospital Outpatient Rehabilitation, Harris Health System, Missouri City, TexasBACKGROUND AND PURPOSE: Cervical myelopathy is a progressive neuro-logical condition that presents with a wide variety of clinical symptoms. Evidence supports surgical intervention to halt further neurological de-cline in function. Given the wide range of signs and symptoms of myelop-athy, diagnosis can be challenging and requires a thorough neurological screening. The ability of a physical therapist to adequately discern the presence of sinister pathologies masked as a musculoskeletal complaint has been a source of concern by some physicians in a direct patient access practice environment. The purpose of this case is to demonstrate a phys-ical therapist’s ability to perform a complete review of systems with em-phasis on neurological testing to make appropriate medical referral in a patient with undiagnosed cervical myelopathy.CASE DESCRIPTION: A 48-year-old woman presented to a hospital-based outpatient orthopaedic physical therapy clinic after being referred by an orthopaedic surgeon for a complaint of chronic right knee pain. Prior to seeing PT, this patient was evaluated by a neurologist due to elevated cre-atine kinase level in the presence of imbalance and gait abnormalities. At that time, deficits were attributed to mechanical knee pain. Upon PT eval-uation, she confirmed insidious onset of knee pain ongoing for 7 months and also endorsed stiffness, difficulty with gait and balance. Physical ther-apist’s evaluation produced findings inconsistent with mechanical knee pain. Furthermore, observational gait analysis prompted more in-depth neurological testing that revealed the presence of pathological reflexes, hyperreflexia and spasticity on multiple limbs with right side more pro-nounced. Per physical therapist’s recommendation, the patient was sent for a follow-up with referring provider as well as neurologist. Orthopedics ordered an MRI of her painful knee, which the radiologist deemed un-remarkable. As recommended by the physical therapist, the patient re-turned for a second consult with a neurologist. An MRI of her cervical spine showed the presence of severe central canal stenosis at C4-5 con-firming the suspected presence of cervical myelopathy.OUTCOMES: Following the physical therapist’s recommendation, the pa-tient received advanced imaging and a new physical exam by a neurol-ogist. A diagnosis of cervical myelopathy was made and the patient was immediately scheduled for decompressive spinal surgery in order to pre-vent further neurologic compromise and maximize functional outcomes.DISCUSSION: This case highlights the importance of continual consider-ation of nonmusculoskeletal problems as the cause of symptoms and the competence of a physical therapist in making appropriate medical refer-rals in light of the presence of red flags. By using a thorough review of sys-tems and sound clinical reasoning, a physical therapist is able to request for additional testing to adequately diagnose the cause of signs and symp-toms noted on examination.


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REFERENCES: Edwards C, Riew D, Anderson P, et al. Cervical myelopa-thy: currect diagnostic and treatment strategies. Spine J. 2003;3:68-81. Elliott J, Flynn T, Al-Naijar A, et al. The pearls and pitfalls of magnetic resonance imaging for the spine. J Orthop Sports Phys Ther. 2011;41:848-860. Flautt W, Westrick R. Cervical myelopathy in a special operations soldier. J Orthop Sports Phys Ther. 2015;45:233. Ren H, LeuF, Yu D, et al. Patterns of neurological recovery after anterior decompression with fusion and posterior decompression with laminoplasty for the treat-ment of multilevel cervical spondylotic myelopathy. Clin Spine Surg. In press. Salvi F, Jones J, Weigert B. The assessment of cervical myelopa-thy. Spine J. 2006;6:1825-1895. Tetreault L, Goldstein C, Arnold P, et al. Degenerative cervical myelopathy: a spectrum of related disorders affect-ing the aging spine. Neurosurgery. 2015:77:S51-S67.

OPO5MENISCAL ABNORMALITIES: A COMPARISON OF ULTRASONOGRAPHY AND MCMURRAY’S TESTEryn K. Apanovitch, Bryon A. Smith, Nicole Limpabandh, Ashalee Cyears, Samantha Perez, Lauren Scheuing, Clara StroudDepartment of Physical Therapy, University of Miami, Miami, FloridaPURPOSE/HYPOTHESIS: Ultrasound is emerging as a viable imaging modal-ity in diagnosis and assessment of the musculoskeletal system. It is un-known whether diagnostic ultrasound can accurately and reliably detect abnormalities of menisci in the knee. In 2014, Sladjan et al investigated accuracy of detecting acute and chronic lateral meniscal lesions with ul-trasound imaging (UI) and determined chronic detection to be 85% sen-sitivity and 90% specificity while acute detection to be 71% and 87% re-spectively. These results indicate that UI is clinically useful for meniscal pathology assessment, but further research must be done concerning clin-ical diagnosis with UI. The purpose of this study was to determine if there is a relationship between physical therapy students identifying meniscal abnormalities using UI and McMurray’s test (MT).NUMBER OF SUBJECTS: Twenty-seven patients with suspected meniscal inju-ries were assessed using UI and MT.MATERIALS/METHODS: Two examiners performed UI on all subjects while 2 additional raters were blinded and performed the MT. UI was performed at the joint line, on the medial and lateral aspects of the knee while pa-tients were positioned supine with their knee at 90° of flexion. The crite-rion for consideration of a meniscal abnormality includes imaging with presentation of inflammation, extrusion of the meniscus, and inconsistent fiber alignment. MT was performed to compare to the meniscal abnor-malities found using UI. A positive test would elicit pain and/or clicking.RESULTS: In 18 of the subjects, meniscal pathology was suspected based on UI. After MT, the first rater identified 15 abnormalities while the second rater detected 16 abnormalities. Further analysis revealed that, for the first rater, 12 of the subjects who tested positive with the MT were sus-pected of having the same meniscal pathology based on the UI (80%). For the second rater 11 of these subjects matched (68.8%).CONCLUSIONS: Results indicate that student physical therapists can accu-rate visualize meniscal pathologies, possibly even tears using UI. UI can be a cost and time efficient tool in the clinical setting for detecting menis-cal abnormalities and can be utilized by physical therapists. At this time specificities in detecting types of meniscal abnormalities is unknown, but research is ongoing.CLINICAL RELEVANCE: The ability of physical therapists to confirm meniscal abnormalities identified through clinical examination (MT) with UI, if re-liable, would benefit the overall health care industry via significant cost reduction and time efficiency. With the expansion of direct access grow-ing nationwide, UI further allows the physical therapist to act as an inde-pendent health care professional without the need for MRI confirmation.

OPO6NORMAL HOLD TIMES OF THE MODIFIED SIDE BRIDGE IN SUBJECTS 30 YEARS AND OLDERMark J. Armstrong, Marsha D. Rutland, Janelle K. O’Connell, Scott Newberry, Kathryn Bromiey, Christopher AdamcikPhysical Therapy, Hardin Simmons University, Abilene, TexasPURPOSE/HYPOTHESIS: The purpose of this study was to (1) determine aver-age maximum endurance hold times for the modified side-bridge (on el-bow and knees) position among healthy subjects 30 to 69 years old, (2) identify relationships between subjects’ characteristics (body mass index and sex)and the modified side-bridge hold times.NUMBER OF SUBJECTS: Thirty subjects per age group participated (30-49 and 50-60 years).MATERIALS/METHODS: A sample of convenience were recruited from uni-versities and local businesses. Following completion of an informed con-sent and health status questionnaire, demographic information was ob-tained. Resting blood pressure, height, weight, body mass index (BMI) were assessed. Prior to testing, initial side-bridge hold side (left or right) was randomly determined. An instructional video was viewed to famil-iarize subjects with the testing procedure. Subjects performed the modi-fied side-bridge on both sides with a 1-minute rest between efforts. One cue was given when the examiner noted deviation from the initial starting position. A second deviation within 15 seconds of the first, or hip contact with the mat terminated the testing procedure. Hold times was limited to a maximum of 3 minutes per side. Independent-samples t tests were used to identify differences in average hold times between age groups (30-49, 50-69), left and right hold sides, and sex. A Pearson correlation was used to identify relationships between BMI, exercise frequency, and hold times.RESULTS: Subjects: n = 60 (23 male, 37 female; mean ± SD age, 47.2 ± 10.9 years) completed the study. The average hold times of the subjects were reported in seconds for sex and age groups: F (30-49 years old) = 100.45 ± 49.4 seconds (right) and 91.01 ± 50.1 seconds (left); M (30-49 years old), 129.63 ± 34.4 seconds (right) and 116.05 ± 38.7 seconds (left); F (50-69 years old) = 109.90 ± 56.7 seconds (right) and 106.49 s ± 42.5 seconds (left); and M (50-69 years old), 127.06 ± 47.7 seconds (right) and 127.02 ± 50.2 seconds (left). Overall, males held the modified side-bridge longer than females with a mean difference of 23.4 seconds right side (P = .038) and 24 seconds left side (P = .027). No significant differences in hold times between age groups (30-49, 50-69) or test sides (right,left) were found. Fair, inverse correlations were found between BMI and hold times (right, r = –0.419; left, r = –0.359). Primary reasons for test termi-nation were hip musculature fatigue in males and arm/shoulder muscu-lar fatigue in females.CONCLUSIONS: Modified side-bridge mean overall hold times in subjects 30 and older is over 1 minute. No significant difference in hold times be-tween left or right sides or age groups were shown. There was a fair, in-verse relationship between BMI classification and hold time. Males held significantly longer than females.CLINICAL RELEVANCE: A modified side bridge is an adapted form for those whom may not be able to perform a full side bridge. Findings of the nor-mal values for the modified side-bridge in healthy individuals 30 to 69 years may serve as useful tool when used clinically as a core endurance outcome measure.

OPO7AN INITIAL INVESTIGATION INTO A CLINICALLY FEASIBLE MEASURE OF MEDIAL LONGITUDINAL ARCH FLEXIBILITYLindsay Backiev, K. Michael Rowley, Hai-Jung Shih, Kornelia KuligDivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CaliforniaPURPOSE/HYPOTHESIS: Medial longitudinal arch (MLA) flexibility is clini-cally important due to its purported association with lower extremity in-


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jury [1-4]. Much literature utilizes a variety of evaluation methods when measuring MLA height [1,5], and while most methods mutually employ the navicular as a bony landmark, small variances result in difficulty com-paring between studies. To assess MLA flexibility independent of abso-lute height, researchers developed a measurement of the foot’s response to compressive loads, relative arch deformation (RAD) the RAD equation described by Nigg and collaborators [6] was later modified by Williams and McClay [7]. Methods reported in the literature are complex proce-dures, however, that may be unreasonable to perform with patients clini-cally such as using scales to load precisely 10% and 90% of body weight [6,7]. We propose a clinically simple method of obtaining 2 comparable measurements to determine RAD: the first seated, approximating an un-loaded condition, and the second a bilateral stance, approximating 50% body weight loading. The purpose of this study was to compare results of this RAD methodology to published methods.NUMBER OF SUBJECTS: Data were collected on the dominant stance foot, de-fined as contralateral to the preferred kicking limb, of each healthy adult participant (n = 45; mean age, 26.5 years; 8 male).MATERIALS/METHODS: Weight, arch height seated (AHU), arch height standing (AH), and truncated foot length were measured and recorded. Arch height was measured at the dorsal aspect of the talonavicular joint. RAD, and AHU and AH normalized to truncated foot length, were calcu-lated. Results were compared against reported mean values of Williams and McClay [7].RESULTS: AHU and AH were significantly greater than the mean heights reported by Williams and McClay (AHU, P<.0001; AH, P<.0001), and there was no difference in truncated foot length (P = .42). Average RAD was calculated as 1.28 ± 0.67 N, significantly larger than the mean val-ue reported by Williams and McClay of 1.05 ± 0.51 N (P = .02, Cohen’s d = 0.39).CONCLUSIONS: Greater absolute arch heights measured in this study can be explained by our procedure of measuring at the dorsal aspect of the talo-navicular joint versus previous definitions of 50% of foot length or high-est aspect of the dorsum, which may result in more intersubject variabil-ity. Greater RAD may also reflect greater motion at this joint line, more indicative of real arch deformation during loading, or may be influenced by an 82% female sample [8]. Future studies will further explore validity, reliability, and functional significance of RAD measures.CLINICAL RELEVANCE: We determined that a simple procedure of measuring arch height while seated, then standing with bilateral weight distribution, is a promising method of measuring RAD and quantifying MLA flexibility.

OPO8RELIABILITY OF FABER MEASUREMENTSJennifer J. Bagwell, Lauren Bauer, Marissa Gradoz, Terry L. GrindstaffCreighton University, Lincoln, NebraskaPURPOSE/HYPOTHESIS: The FABER (Flexion ABduction External Rotation) test is an indicator of hip pain and range of motion (ROM) with empha-sis on side-to-side asymmetry. Normative and reliability data regard-ing FABER are lacking. Additionally, while thigh length would influ-ence FABER height, no study has examined use of an inclinometer versus standard ruler or considered normalization to thigh length. Therefore, the purposes of this study were to determine normative values and in-ter and intrarater reliability of FABER height, thigh length normalized FABER, and interlimb FABER differences. We also compared intrarater reliability of FABER measured via a ruler, thigh length normalized, and via inclinometry.NUMBER OF SUBJECTS: Nineteen participants without hip, knee, or lumbar spine pain (11 female, 8 male; mean ± SD age 23.5 ± 1.2 years).MATERIALS/METHODS: Three testers performed measurements during 2 ses-sions (3-7 days between sessions). Passive FABER ROM was measured with the participant in the figure 4 position using a ruler (perpendicular distance from the lateral femoral epicondyle to table) and with an incli-

nometer. Next, thigh length was measured between the greater trochan-ter and the lateral epicondyle of the femur and was used to normalize FABER values obtained with the ruler (FABER/thigh length). The dif-ference between limbs was calculated as the absolute value of right mi-nus left FABER ruler measurements. Interrater and intrarater reliabili-ty were calculated in SPSS using interclass correlation coefficients (ICC). Minimal detectable change (MDC) was also calculated (standard error of the measure × 1.96 × √2).RESULTS: Mean values for right/left FABER height were 12.3 ± 2.9 cm and 12.4 ± 2.7 cm. Mean thigh length normalized FABER for right/left were 0.29 ± 0.07 and 0.30 ± 0.07. Interrater reliability for height and normal-ized height were good (ICC = 0.62-0.73) and between session intrarater reliability were good to excellent (ICC = 0.70-0.88). FABER height and normalized FABER MDC for the 3 testers ranged from 1.2 to 1.9 cm and 0.02 to 0.05, respectively. Mean FABER difference was 2.0 ± 0.9 cm with poor interrater reliability (ICC = 0.20), poor to good intrarater reliability (ICC = 0.38-0.66), and an MDC of 1.3 to 2.0 cm. FABER height measured with a ruler, normalized height, and inclinometry all resulted in excellent intrarater reliability, with the highest ICC for inclinometry (ICC = 0.84-0.87, 0.83-0.88, and 0.87-0.95).CONCLUSIONS: Overall, FABER measurements were reliable, whether nor-malized to thigh length or not. Furthermore, results indicate that use of an inclinometer may increase reliability. However, we found poor to good reliability for assessment of interlimb differences in FABER.CLINICAL RELEVANCE: This study established normative and MDC values for FABER and demonstrated that FABER measurements can be used reli-ability. However, due to poor to good reliability when assessing interlimb differences, more research is necessary to determine if FABER asymme-tries can be reliably used to identify potential hip pathology, as has been suggested clinically.

OPO9DIFFERENCES IN KNEE AND HIP ADDUCTION AND HIP MUSCLE ACTIVATION IN RUNNERS WITH AND WITHOUT ILIOTIBIAL BAND SYNDROMERobert L. Baker, Richard B. Souza, Christopher Powers, Mitchell J. Rauh, Mike Fredericson, Michael D. RosenthalPhysical Therapy, University of California San Francisco, San Francisco, California; Sports and Orthopedics, Rocky Mountain University of Health Professions, Provo, Utah; Physical Therapy, University of Southern California, Los Angeles, California; Physical Therapy, San Diego State University, San Diego, California; Sports Medicine, Stanford University, Palo Alto, CaliforniaPURPOSE/HYPOTHESIS: Increased hip and knee adduction has been report-ed in runners with iliotibial band syndrome. Recent reports have focused on the hip and neuromuscular factors to determine who may be at great-er risk. The influence of muscle activation in the hip muscles has not been reported. We hypothesized that increased hip and knee adduction would be associated with increased tensor fasciae latae muscle activation, re-duced gluteus medius and gluteus maximus muscle activation. The kine-matic and activation differences were expected to be greater at 30 min-utes than 3 minutes of running.NUMBER OF SUBJECTS: Thirty.MATERIALS/METHODS: Motion capture and surface electromyography were performed on 15 runners with iliotibial band syndrome and 15 matched controls. The average muscle activation was compared for the gluteus me-dius, gluteus maximus and tensor fasciae latae muscles. Kinematics were compared for peak hip adduction and knee adduction. Data were collect-ed at 3 minutes and 30 minutes.RESULTS: Injured runners demonstrated increased knee adduction com-pared to control runners at 30 minutes (P = .002; control, –1.48°; injured, 3.74°). The tensor fasciae latae (TFL) muscle activation in injured run-ners was increased compared to control runners at 3 minutes (P = .017).CONCLUSIONS: The results of this study suggest that injured runners had increased knee adduction at 30 minutes and increased TFL muscle acti-


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vation at 3 minutes.CLINICAL RELEVANCE: These findings were consistent with neuromuscular factors of the hip muscles and increased knee adduction in runners with iliotibial band syndrome. This study confirms the need to further inves-tigate hip muscle control as an influence on kinematic deviations of the knee in patients with iliotibial band syndrome. In addition, the increased deviation in knee adduction needs further investigation as a factor that af-fects kinematic changes during a prolonged run.

OPO10A SURVEY OF PHYSICAL THERAPISTS’ UTILIZATION OF THE PILATES METHOD IN REHABILITATIONDebra Bangs, Candice Carajohn, Chelsea AaronThe Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Wrentham, MassachusettsPURPOSE/HYPOTHESIS: Physical therapists are incorporating Pilates equip-ment, and mat exercises into treatments. Patients often seek guidance to determine readiness for returning to Pilates following injury. This study’s purpose was to: determine PTs utilization of Pilates in practice, their opinions regarding Pilates education and determine if associations exist between utilization of Pilates, years of experience, region of practice and personal utilization.NUMBER OF SUBJECTS: One hundred thirty-two.MATERIALS/METHODS: The survey was sent electronically to 2166 members of the American Academy of Orthopedic Manual Physical Therapists and to 17 000 members of the Orthopaedic Section of the APTA through the Osteoblast newsletter. 150 PTs responded to the survey, 18 were incom-plete and 132 responses were analyzed. Descriptive and chi-square statis-tics were used to describe the data and determine if correlations existed between variables.RESULTS: Thirty-six percent of respondents utilize the Pilates Method in practice, 81% incorporate mat exercises, 50% equipment, 50% refer pa-tients to classes at other facilities and 27% refer to Pilates instructors at their facilities. 48% of respondents practice Pilates themselves while 68% recommend Pilates to their patients. Of this group, 67% recom-mend small group classes and 53% recommend private lessons. 73% of respondents aren’t trained in Pilates and 53% of them were interested in learning more about Pilates. 48% preferred a weekend course while 42% would prefer an online course. There was an association between PTs who practiced Pilates themselves and PTs who utilized Pilates in their practice with a P<.001. No other significant associations were found. 94% of re-spondents felt that more research is needed regarding the benefits of the Pilates Method.CONCLUSIONS: PTs should have some training in Pilates to be able to appro-priately and safely refer their patients to Pilates classes. There is a missed opportunity by practice owners who would benefit from offering Pilates classes onsite. PTs who practice Pilates themselves were more likely to utilize Pilates with their patients. This may indicate that PTs who prac-tice Pilates have a better understanding of the benefits and principles of Pilates making them more likely to utilize Pilates with their patients. If there was further research and education regarding Pilates, utilization rates may increase. Overwhelmingly respondents see the value in further research into the benefits of Pilates.CLINICAL RELEVANCE: It’s important to understand the educational needs of the PT population with respect to Pilates. PTs are referring patients to Pilates and patients come to PT with a desire to return to Pilates classes. It is incumbent on PTs to have an understanding of what Pilates is and how to safely perform Pilates exercises following injury and recovery. This survey has shown that not only does the PT community wish to see more evidence regarding Pilates but there is a need for further education re-garding the Pilates method.

OPO11THE RELATIONSHIP BETWEEN THORACIC AND LUMBAR SPINE REPOSITIONING ERROR IN ASYMPTOMATIC YOUNG ADULTSBrian Baranyi, Bradley Myers, Aaron Keil, Deborah DaveyUniversity of Illinois at Chicago, Chicago, IllinoisPURPOSE/HYPOTHESIS: Recent literature has highlighted the potential for motor control deficits as underlying factors in the development of acute low back pain (LBP) or as factors that contribute to ongoing, chronic LBP. Spinal motor control may be represented through the measurement of Repositioning Error (RPE). Altered lumbar RPE has been identified in patients with LBP and may indicate altered central nervous system pro-cessing and reduced proprioceptive awareness. These findings are well es-tablished for the lumbar spine, however the relationship between thoracic and lumbar spine RPE has not been reported. A recent systematic review revealed that lumbar RPE has not been assessed beyond 10 repetitions, leaving the effect of higher repetition tasks in asymptomatic individuals unknown. The purpose of this study is to determine the relationship be-tween thoracic and lumbar RPE during a high repetition trunk flexion task in asymptomatic young adults.NUMBER OF SUBJECTS: Twenty-eight asymptomatic individuals between the ages of 23 and 29 participated in this study (8 male, 20 female; mean ± SD age, 24.91 ± 2.044 years). Participants had no history of spinal injury or thoracic/lumbar pain requiring medical care in the last 2 years.MATERIALS/METHODS: Anatomical markers were placed at the T4 and L2 spinous processes. Participants were placed in a seated position and asked to perform 50 repetitions of trunk flexion, at a self-selected speed, and were instructed to return to the starting position after each repetition. RPE was measured at T4 and L2 as the absolute distance from the start-ing position with the use of Dartfish video analysis software. Cumulative Repositioning Error (CRPE) was calculated in increments of 10 repeti-tions for both T4 and L2 spinal levels, in order to identify potential chang-es in relationship as the repetitions increased.RESULTS: Thoracic and lumbar CRPE were strongly and significantly (P<.05) correlated throughout all 50 repetitions and the strength of cor-relation was greatest in the largest repetition range. Repetition range and the associated Pearson’s r are supplied below: 1-10, 0.687; 1-20, 0.680; 1-30, 0.710; 1-40, 0.745; 1-50, 0.773.CONCLUSIONS: As the repetitions increased past 20, so did the strength of correlation between thoracic and lumbar spine CRPE. The positive na-ture of the correlation also indicates that as absolute thoracic spine RPE increases, so does lumbar spine RPE.CLINICAL RELEVANCE: The majority of research and intervention related to spinal RPE has focused on the lumbar spine. Given the greater ability for thoracic spine motion and the strong relationship between thoracic and lumbar spine RPE, especially as repetitions increase, perhaps more at-tention to motor control of the entire spine is needed. Motor control def-icits at the thoracic spine may contribute to deficits at the lumbar spine. Future research is needed to determine whether motor control interven-tion at the thoracic spine can influence RPE of the lumbar spine, and whether or not these factors may contribute to the development and per-sistence of low back pain.

OPO12THE RECOGNITION AND TREATMENT OF AMPLIFIED PAIN SYNDROME FOLLOWING SALTER-HARRIS FRACTUREBrittney BarrieRehab at Magnolia Parke, UF Health, Gainesville, FloridaBACKGROUND AND PURPOSE: Chronic pain in children and adolescents can be treated effectively with a multidisciplinary approach including physi-cal therapy. Amplified Pain Syndrome can occur following an orthopae-dic injury or trauma in adolescents and may contribute to adult chronic pain syndromes. Treatment of amplified pain syndrome using a multidis-ciplinary biopsychosocial treatment strategy is effective, however there


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is a lack of practical, specific published treatment protocols available to guide physical therapists who may encounter this disorder in the outpa-tient setting. This case report serves to describe the treatment and as-sociated outcomes in an 8-year-old child presenting with Salter Harris fracture who developed Amplified Pain Syndrome. Treatment strategies included functional neuromuscular re-education, desensitization tech-niques, graded exposure, and psychological interventions.CASE DESCRIPTION: An 8-year-old girl was referred for treatment in an out-patient physical therapy setting for Salter Harris fracture of the right dis-tal fibula following cast removal. She began physical therapy to address physical impairments related to immobilization. Potential amplified pain symptoms were noted at initial evaluation presenting as allodynia to light and rough touch as well as avoidance of all weight bearing on right low-er extremity. Over the course of 1 month, she developed pain in the con-tralateral limb, bilateral wrists and hands, generalized hyperalgesia, ab-dominal pains, and headache and was diagnosed with Amplified Pain Syndrome. Treatment strategies expanded to include education to the patient and family regarding central nervous system sensitization, psy-chological interventions including mindfulness activities, and pain coping strategies. The treatment team was also expanded to include Cognitive Behavioral Therapy and Occupational Therapy based on successful treatment outcomes in pain rehabilitation programs. The patient was seen for 57 visits over 10 months. Outcome criteria included pain mea-sures (FACES scale), functional self-report measures (Lower Extremity Functional Scale [LEFS]), gait and biomechanical task analysis.OUTCOMES: The patient improved in all quantitative and qualitative out-comes. She met all functional age-appropriate milestones and gross motor skills without compensatory patterns including running, jumping, skip-ping, crawling, and stair climbing. The patient resumed all school activi-ties with minimal modifications (compressive garments and seated on a pillow) and returned to participating in organized swimming and soccer. Clinically meaningful improvements were observed in pain and the LEFS.DISCUSSION: The results of this case study describe the management of a child referred to physical therapy with an orthopaedic injury which devel-oped into Amplified Pain Syndrome. The use of a holistic biopsychosocial management approach and a multidisciplinary team was associated with clinically meaningful improvements in pain and function and resumption of her usual school and recreational activity participation.REFERENCES: 1. Landry BW, et al. Managing chronic pain in children and adolescents: a clinical review. PM R. 2015:5295-5315. 2. Sherry, D. An overview of amplified musculoskeletal pain syndromes. J Rheum. 2000;27:44-48. 3. Hoffart CM, Wallace, DP. Amplified pain syndromes in children: treatment and new insights into disease pathogenesis. Curr Opin Rheum. 2014;26:592-601. 4. Walker LS, et al. Functional abdomi-nal pain in childhood and adolescence increases risk for chronic pain in adulthood. Pain. 2010;150:568-572. 5. Jiao J et al. Physical trauma and infection as precipitating factors in patients with fibromyalgia. Am J Phys Med Rehabil. 2016. 6. Stanton-Hicks, M. Plasticity of complex region-al pain syndrome (CRPS) in children. Pain Med. 2010;11:1216-1223. 7. Sherry, DD, et al. The treatment of juvenile fibromyalgia with an intensive physical and psychological program. J Peds. 2015;167:731-737.

OPO13COMBINED EFFECTS OF WEIGHT GAIN AND REDUCED WALKING SPEED ON TIBIOFEMORAL CONTACT FORCES: EXPERIMENTAL SIMULATION OF CHANGES TYPICAL OF OSTEOARTHRITISJoaquin Barrios, Christopher Colatruglio, Matthew Cox, David Farwick, Louis Fullenkamp, Kevin P. O’Brien, Justin Seekins, John D. WillsonPhysical Therapy, University of Dayton, Dayton, Ohio; Physical Therapy, East Carolina University, Greenville, North CarolinaPURPOSE/HYPOTHESIS: Weight gain and reduced walking speed typical-ly accompany knee osteoarthritis. However, the combined effect of these changes on the knee joint loading environment is unclear. Thus, the pri-

mary purpose of this study was to experimentally simulate weight gain and slowed walking speed to observe the effects on tibiofemoral and me-dial compartment contact forces during walking. It was hypothesized that peak contact force and contact force by time (impulse) would increase. Secondarily, the changes in joint contact forces were compared against minimum detectable change (MDC) thresholds, testing the hypothesis that impulse data would be more sensitive to these experimental effects than peak forces.NUMBER OF SUBJECTS: Thirty (16 female; mean ± SD age, 23.0 ± 1.4 years; weight,69.1 ± 13.8 kg; height, 1.70 ± 0.09 m) healthy participants.MATERIALS/METHODS: Three-dimensional gait analysis was performed for 2 walking conditions: a self-selected speed and an experimental condi-tion involving a 10% reduction in walking speed and a vest loaded with 10% body weight. An inverse dynamics driven knee joint model previous-ly validated against in vivo tibiofemoral compartment loads was used to estimate tibiofemoral and medial compartment peak force and impulse data, which were compared between conditions using paired t tests and effect sizes. The difference between conditions was also assessed relative to MDC thresholds derived from reliability testing. The proportion of par-ticipants who showed changes in peak tibiofemoral and medial compart-ment force exceeding the MDC was compared with the proportion who showed impulse changes exceeding the MDC during the experimental condition using Fisher’s exact test (all tests, α = .05).RESULTS: Peak contact force for the tibiofemoral joint (P<.001; ES, 0.21) and medial compartment (P<.001; ES, 0.19) showed small increases in the experimental condition. Impulse changes were much larger for both the tibiofemoral joint (P<.001; ES, 1.01) and the medial compartment (P<.001; ES, 1.05). When assessed against the MDCs for peak tibiofemo-ral and medial compartment forces, 10% and 13% of participants showed increases greater than the MDC, respectively. Conversely, 97% (P<.001) and 100% (P<.001) of participants experienced increased tibiofemoral and medial compartment impulse greater than the MDC, respectively.CONCLUSIONS: Increased tibiofemoral and medial compartment peak force and impulse values were observed when walking 10% slower and with 10% weight gain. Joint impulses were much more sensitive metrics of these experimental effects than peak forces.CLINICAL RELEVANCE: Increasing body weight and walking slower conjoint-ly increase knee contact forces, but this effect is more evident using time-dependent loading metrics than peak loads. As progression of knee OA appears more closely associated with knee joint force impulse than peak values during gait, clinicians may consider both body weight and walking speed management as therapeutic targets.

OPO14LOW BACK PAIN IS ASSOCIATED WITH INCREASED RESTING STIFFNESS OF THE LUMBAR MUSCLES: A SHEAR-WAVE ELASTOGRAPHY IMAGING STUDYEmily Barth, Shane Koppenhaver, Amber Davis, Laura Eberle, Laurel Proulx, Brian A. Young, Jeffrey HebertUS Army-Baylor University, San Antonio, Texas; Murdoch University, Perth, AustraliaPURPOSE/HYPOTHESIS: Dysfunction of lumbar musculature is common-ly implicated in low back pain (LBP) [1,3]. Ultrasound shear wave elas-tography (SWE) uses the propagation of transverse shear waves in con-junction with B-mode ultrasound imaging to estimate the stiffness (shear modulus) of soft tissues. This emergent technology estimates individual muscle contraction and quantifies local areas of muscle function in peo-ple with LBP [2,4,6]. No previous studies have quantified lumbar muscle function with SWE. Therefore, the primary purpose of this study was to compare resting and contracted stiffness of lumbar multifidus (LM) and paraspinal (PS) musculature in individuals with and without LBP. We hy-pothesized that individuals with LBP will have higher resting muscle stiff-ness and lower contracted muscle stiffness than asymptomatic individu-als. Additionally we sought to examine the relationship between lumbar muscle stiffness outcomes and findings from a standardized clinical ex-


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amination in individuals with LBP.NUMBER OF SUBJECTS: One hundred twenty individuals (60 with current mechanical LBP and 60 without current LBP) volunteered to participate (average ± SD age, 31 ± 7 years; 51.7% male, 48.3% female; BMI, 25.4 ± 2.9 kg/m2).MATERIALS/METHODS: All subjects underwent a standardized clinical exam-ination followed by SWE stiffness measures of the LM and PS muscles at rest as well as the LM during submaximal contraction [5]. Images of the LM and PS muscles were captured at the right L4 level in asymptomat-ic subjects and on the painful side at the most painful level of the L3, L4, or L5 vertebral levels in patients with LBP. Stiffness (shear modulus) was compared between individuals with and without LBP using independent t tests. The bivariate relationship between lumbar muscle stiffness and various clinical examination findings were analyzed using Pearson’s r and point biserial correlations in individuals with LBP.RESULTS: Mean ± SD LM resting stiffness was higher in individuals with LBP (20.4 ± 9.6 kPa) than without LBP (17.1 ± 5.9 kPa) (P = .03). Mean ± SD PS resting stiffness was higher in individuals with LBP (19.2 ± 10.1 kPa) than without LBP (13.4 ± 5.0 kPa) (P<.001). Mean ± SD LM submax-imal contraction stiffness was not different between individuals with LBP (62.3 ± 32.5 kPa) and without LBP (67.9 ± 29.4 kPa) (P = .32). Correlations between clinical exam findings and shear modulus were not significant.CONCLUSIONS: Subjects with LBP had greater resting but not contracted lumbar muscle stiffness than asymptomatic individuals. These findings support an association between LBP and with increased lumbar mus-cle tone.CLINICAL RELEVANCE: Individuals with LBP have greater resting lumbar muscle stiffness than individuals without LBP. This is consistent with a pattern of increased lumbar muscle tone with LBP.

OPO15PERFORMANCE AND RELIABILITY OF THE CERVICAL JOINT POSITION ERROR TEST IN HIGH SCHOOL ATHLETESRyan Bean, Laura Smith, Becky J. Rodda, Bara AlsalaheenPhysical Therapy, University of Michigan Flint, Davison, MichiganPURPOSE/HYPOTHESIS: The cervical joint position error test (CJPET) pro-vides an objective measure of neck reposition sense and has been shown to document differences between healthy controls and individuals suffer-ing from whiplash associated disorders and chronic neck pain. The ma-jority of these studies assessed middle aged individuals and some have as-sessed younger adults (18-19 years old). With the number of adolescents participating in high school sports on the rise along with the number of sports injuries involving the head and neck, having performance data and information on the reliability of this test in this population is needed. The primary purpose of this study is to (1) describe the performance of the Cervical Joint Position Test Error (CJPET) in a cross-sectional population of adolescents, (2) examine the associations between sex, age, and body mass on the performance of the CJPET, and (3) describe the test-retest reliability of the CJPET in a subsample of adolescents.NUMBER OF SUBJECTS: One hundred eighteen high school athletes (91 male, 27 female) with an average ± SD age of 15.07 ± 1.15 years.MATERIALS/METHODS: Subjects performed the cervical joint position error test that included 6 measurements in each direction (flexion, extension, right rotation, and left rotation). The head mounted laser method was used and order of direction of testing was randomized. Seventeen of these participants performed the test at 2 different times to assess the reliability of the cervical joint position error test. The distance in error was recorded in cm and converted to degrees of error.RESULTS: Average error for all directions combined was 3.59° + 1.31°. Extension had the highest frequency of error at 33% of the participants. Ninety-five of the 118 (80.51%) participants were classified as “abnormal” using the accepted norm as 4.5° as the cutoff point. There was an inverse correlation (r = –0.218, P = .018) with relation of BMI and total number

of joint positions classified as abnormal. There were no significant cor-relation between sexes (P = .75) and with age (r = –0.134, P = .152) ICCs ranged from 0.70 to 0.87, indicating moderate to good reliability in all di-rections. The majority of MDC was between 2.2° to 4.7°, with extension being the highest.CONCLUSIONS: There appears there are larger errors in the healthy adoles-cent population as compared to healthy adults resulting in the possibili-ty of needing a larger error accepted cut-off point for this younger popu-lation compared to the 4.5° currently used in adults. BMI has an impact on the performance of the CJPET (those with higher BMI had a reduced amount of errors). The CJPET appears to be a reliable assessment tool in this population.CLINICAL RELEVANCE: This study was the first to the author’s knowledge to analyze the performance characteristics of adolescent population on the CJPET. Having performance measures of the CJPET in this popula-tion could be a reference for clinicians treating an adolescent patient with neck pain or whiplash as these injuries are occurring at an increased rate in the high school population.

OPO16SCREENING FOR LATERAL PROCESS OF TALUS FRACTURE IN PHYSICAL THERAPYJennifer J. Bell, Samuel Cotnoir, Maggie WarrenSchool of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MontanaBACKGROUND AND PURPOSE: Fracture of the lateral process of the talus (LPT) is a rare injury, making up 0.86% of 1500 cases of ankle sprains or fractures. This fracture often presents with signs and symptoms similar to a severe ankle sprain, which leads to misdiagnosis and definitive treat-ment [1-3]. According to a study of 39 cases of LPT fracture, only 59% were correctly diagnosed initially. This study shows that these fractures are difficult to see on plain radiographs, increasing the probability of be-ing missed upon initial examination [4]. Long term consequences of mis-diagnosed LPT fractures include lateral hindfoot impingement [5], loose bodies in the subtalar joint [6], malunion, nonunion, posttraumatic ar-thritis, or avascular necrosis [7,8].CASE DESCRIPTION: A 24-year-old female student presented to PT 8 days af-ter a fall while ice climbing. The patient landed on her left foot, which be-came fixed in dorsiflexion due to the nature of her ice climbing boots and crampons. Immediately after the fall, she was unable to weight bear and presented to urgent care the next day. Standard AP, lateral, and mortise radiographs were taken and the PA read them as normal. The PT evalu-ation found moderate ankle pain, tenderness along both malleoli, ante-rior talofibular ligament and insertion of the Achilles. Significant edema and bruising were observed on the medial and lateral aspects of her ankle and anterior tibia. Passive and active motion was limited in all directions. Special tests revealed marked laxity in the anterior and posterior talofib-ular and calcaneal fibular ligaments.OUTCOMES: Due to the high-energy mechanism of injury (MOI), lack of improvement in weight bearing, significant pain, and positive ligamen-tous testing, PT was ceased. She was referred to the student health cen-ter for more imaging due to the high level of suspicion of an undiagnosed fracture or complex ligamentous injury. The patient had an MRI which revealed a left displaced LPT fracture. Subsequently, the patient was re-ferred to an orthopaedic surgeon for definitive ORIF of the LPT. The sur-geon reported no complications. But, he did report finding a small de-tachment of articular cartilage from the posterior calcaneus. This should have no long-standing effect on the patient’s prognosis.DISCUSSION: It is essential for PTs to know the MOI and presentation of LPT fractures as many are missed at initial evaluation and with plain radiographs. PTs should suspect an LPT fracture in patients with inju-ries resulting from high impact loading in dorsiflexion. Upon exam, pa-tients may have significant pain, inability to weight bear, tenderness distal and anterior to the lateral malleolus, and severe edema and ecchymosis.


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Clinicians should also rule out LPT fracture in patients with nonhealing ankle sprains due to the potential for misdiagnosis. Using the patient’s history of the MOI and clinical findings, PTs can screen for this common-ly missed fracture to minimize long term repercussions and secure defin-itive treatment in a timely fashion.REFERENCES: 1. Perera A, Baker JF, Lui DF, Stephens MM. The manage-ment and outcome of lateral process fracture of the talus. Foot Ankle Surg. 2010;16:15-20. 2. Worsham JR, Elliott MR, Harris AM. Open calcane-us fractures and associated injuries. J Foot Ankle Surg. 2016;55:68-71. 3. Mukherjee SK, Pringle RM, Baxter AD. Fracture of the lateral pro-cess of the talus. A report of 13 cases. J Bone Joint Surg Br. 1974;56:263-273. 4. Mills HJ, Horne G. Fractures of the lateral process of the talus. Aust N Z J Surg. 1987;57:643-646. 5. Wang PH, Su WR, Jou IM. Lateral hindfoot impingement after nonunion of fracture of the lateral process of the talus. J Foot Ankle Surg. 2016;55:387-390. 6. Bali K, Prabhakar S, Gahlot N, Dhillon MS. Neglected lateral process of talus fracture present-ing as a loose body in tarsal canal. Chin J Traumatol. 2011;14:379-382. 7. Miller S. Fractures of the lateral process of the talus: snowboarder’s frac-ture. Update 2008. The Proceedings of the Annual Meeting of the Podiatry Institute: The Podiatry Institute; 2008:119-123. 8. Tucker DJ, Feder JM, Boylan JP. Fractures of the lateral process of the talus: 2 case reports and a comprehensive literature review. Foot Ankle Int. 1998;19:641-646.

OPO17CHANGES IN LUMBAR MULTIFIDUS MUSCLE THICKNESS DURING COMMON SPINE STABILIZATION EXERCISES USING REHABILITATIVE ULTRASOUND IMAGINGBarbara Belyea, Lisa Bates, Ellen FitzPatrick, Jonah Larson, Kyle McKeighan, Jaime OdinPhysical Therapy, Ithaca College, Ithaca, New YorkPURPOSE/HYPOTHESIS: Lumbar paraspinal musculature, particularly the lumbar multifidus muscle (LMM), plays a key role in spinal stability dur-ing dynamic activities. Selective exercises targeting the core muscles has been shown to be effective for improving spinal stability; however, effica-cy of these exercises has yet to be determined. Rehabilitative ultrasound imaging (RUSI) has been utilized to assess changes in muscle thickness reflective of muscle activation. The purpose of this study was to deter-mine which commonly prescribed core exercises demonstrated the great-est change in LMM thickness using RUSI.NUMBER OF SUBJECTS: Twenty healthy subjects (10 female, 10 male; mean age, 23.75 years; height, 67.625 inches; weight, 154.6 lb; body mass in-dex, 23.46 kg/m2).MATERIALS/METHODS: Prior to data collection, intra and intertester reli-ability of the 6 testers using RUSI was determined by measuring LMM thickness on 6 different subjects. Data collection included using RUSI to measure thickness changes of the right LMM at the level of the fourth lumbar vertebrae while 4 commonly prescribed trunk stabilization exer-cises were performed. The exercises included: prone superman, bird dog, seated row, and Paloff Press. Thickness changes were determined by sub-tracting the LMM thickness at rest from the thickness at peak contrac-tion, and the change for 3 trials of each exercise was averaged for analysis. Cronbach’s alpha and Intraclass correlation coefficients (ICC) were used to determine intratester and intertester reliability of RUSI measurements of the LMM. A 1-way analysis of variance (ANOVA) was used to deter-mine significant changes in muscle thickness for each exercise.RESULTS: Four out of the 5 testers demonstrated strong intratester reli-ability with values that ranged from 0.81 to 0.99, with 1 tester falling out-side that range (0.27). Intertester reliability was moderately strong with a value of 0.753. All 4 exercises showed increases in LMM thickness, but significant increases were seen in the superman (P<.01) and bird dog ex-ercises (P = .01).CONCLUSIONS: Increases in LMM thickness varied across 4 commonly pre-scribed core stabilization exercises among healthy young adults. The re-sults suggest that prone and quadruped positions may isolate LMM more

effectively than exercises in seated and standing positions.CLINICAL RELEVANCE: Knowledge about muscle activation in lumbar stabi-lizers during certain exercises may be helpful when prescribing exercises for patients with low back pain related to trunk instability.

OPO18PSYCHOLOGICALLY INFORMED PHYSICAL THERAPY: DESCRIBING TREATMENT MONITORING FOR HIGH-RISK LOW BACK PAINJason Beneciuk, Steven GeorgePhysical Therapy, University of Florida, Gainesville, FloridaPURPOSE/HYPOTHESIS: Psychologically informed physical therapy (PIPT) for low back pain (LBP) involves targeting psychological factors in conjunc-tion with impairment based physical therapy. Treatment monitoring is an important part of PIPT and involves identifying changes in key process measures to better inform clinical decision making. Therefore, the purpose of this case series was to describe treatment monitoring during a 4-week period for patients with LBP and high risk for prolonged disability.NUMBER OF SUBJECTS: Patients (n = 23) identified as high risk using the STarT Back Tool and enrolled in a preliminary pragmatic implementa-tion study.MATERIALS/METHODS: Physical therapists (n = 5) were educated on us-ing psychological measures (Fear-Avoidance Beliefs Questionnaire [FABQ-PA, FABQ-W], Tampa Scale of Kinesiophobia [TSK-11], Pain Catastrophizing Scale [PCS] and Fear of Daily Activities Questionnaire [FDAQ]) for treatment monitoring. Outcome measures (numeric pain rating scale [NPRS], Oswestry Disability Index [ODI] and lumbar flex-ion range-of-motion [ROM]) were administered at intake and 4 weeks later. Spearman’s rho correlation coefficients were calculated to identi-fy univariate relationships among psychological and clinical measure change scores. One-way analysis of covariance (controlling for baseline outcome measure) was used to identify how change in psychological mea-sure and 4-week clinical outcomes were associated.RESULTS: Moderate to strong positive associations among all psychologi-cal measure change scores were observed (r = 0.51-0.79, P<.01). Changes in FABQ-PA, PCS and TSK-11 scores were correlated with changes in ODI scores (r = 0.48-0.78, P<.05) while only FABQ-PA change scores were correlated with changes in lumbar flexion ROM (r = –0.68, P<.01). Associations between psychological measure and NPRS change scores were weak (r = 0.01-0.25, P>.05). After controlling for intake ODI scores, change in FABQ-PA (P<.01; partial η2 = 0.42) and PCS (P<.05, partial η2 = 0.28) scores contributed to 4-week ODI scores. Similar associations were not identified for 4-week NPRS or lumbar flexion ROM (P>.05).CONCLUSIONS: Several psychological measures have the potential to aid clinical decision making for self-reported disability, while only FABQ-PA was correlated to physical impairment. Treatment monitoring for pain in-tensity was not supported in this sample.CLINICAL RELEVANCE: Treatment monitoring during PIPT has potential to enhance clinical decision making by identifying certain aspects of treat-ment that may require additional attention to obtain optimal clinical outcomes for patients at higher risk for poor LBP outcomes. Using psy-chological measures seems to have stronger implications for disability outcomes, with further research required for identifying measures that exhibit stronger covariation with pain intensity outcomes.

OPO19DISCRIMINATIVE AND RELIABILITY ASSESSMENT OF PARASPINAL MUSCLE CROSS-SECTIONAL AREA MEASUREMENTS FROM MAGNETIC RESONANCE IMAGES OF PERSONS WITH LOW BACK PAIN IN NOVICE EXAMINERS: A NEW CLINICAL MEASUREGeorge J. Beneck, Kristen Andrion, Jared LeeperPhysical Therapy, California State University, Long Beach, Long Beach, CaliforniaPURPOSE/HYPOTHESIS: Lumbar paraspinal muscle (PM) atrophy is common in persons with low back pain (LBP). Clinical methods to quantify PM


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size are limited. Patients with chronic low back pain and patients await-ing microdiscectomy frequently receive magnetic resonance (MR) images which can be examined by the treating clinician. The purpose of this study was to determine the reliability and discriminative validity of PM (erector spinae (ES), psoas (PS) and quadratus lumborum (QL)) cross-sectional area (CSA) measurements performed by novice examiners.NUMBER OF SUBJECTS: MR images from 3 groups: (1) chronic LBP, mild dis-ability, n = 14; (2) matched group without LBP, n = 14; (3) 14 unmatched patients awaiting microdiscectomy.MATERIALS/METHODS: Two groups of 4 examiners (2 physical therapy stu-dents and 2 orthopaedic physical therapists), performed the measure-ments. Each received 1 hour of instruction and a manual to perform measurements using ImageJ software (Free NIH download) prior to per-forming the measurements. Each examiner, blinded to group, performed PM and L5 vertebral body (VB) CSA measurements from each image se-ries. CSA values were normalized to vertebral body (VB) CSA to generate a PM/VB ratio to normalize for body size differences. Intraclass correla-tion coefficients (ICCs) were calculated to estimate reliability. Area under the curve (AUC) of the receiver operator characteristic curve was calcu-lated to determine if the measurements could discriminate between per-sons with and without LBP.RESULTS: Interexaminer reliability consisted of 18 comparisons across the 3 patient groups. For ES, agreement was moderate to substantial in all comparisons (ICC range, 0.70-0.95) of muscle CSA. Agreement was sub-stantial in 17 of 18 comparisons (ICC range, 0.79-0.97) of ES/VB ratio. For PS, agreement was moderate to substantial in 17 of 18 comparisons (ICC range, 0.70-0.95) of muscle CSA. Agreement was moderate to sub-stantial in 15 of 18 comparisons (ICC range, 0.53-0.99) of PS/VB ratio. For QL, agreement was moderate to substantial in 15 of 18 comparisons (ICC range, 0.76-0.97) of muscle CSA. Agreement was moderate to sub-stantial in 16 of 18 comparisons (ICC range, 0.51-0.96) of QL/VB ratio. Three of 4 examiners showed significant discriminative validity between healthy and premicrodiscectomy groups with either QL CSA or QL/VB ratio (AUC range, 0.73-0.80; P<.05). No discriminative validity was dem-onstrated by any examiner using ES or PM.CONCLUSIONS: PM measurements from MR images have adequate inter-examiner reliability in novice examiners. MR image measurements of QL may be a valid discriminative tool for novice examiners.CLINICAL RELEVANCE: Physical therapists should consider using this method of muscle measurement to quantify muscle loss in persons with low back pain. Such findings could enhance decisions regarding exercise prescrip-tion for the lumbar paraspinal muscles.

OPO20THE EFFECTS OF LUMBAR ROTATIONAL MANIPULATION ON GLUTEAL MUSCLE ACTIVATION DURING FUNCTIONAL ACTIVITIES IN PERSONS WITH CHRONIC LOW BACK PAINGeorge J. Beneck, Cassandra Hippensteel, Jessie ByersPhysical Therapy, California State University, Long Beach, Long Beach, CaliforniaPURPOSE/HYPOTHESIS: Evidence supports the effectiveness of spinal manip-ulative therapy (SMT) for persons with chronic low back pain. However, little is known regarding the underlying mechanisms for its effectiveness. Improved muscle activation following mobilization or manipulation has been reported in the multifidus, abdominal muscles and quadriceps. Recent evidence supports the premise that impaired gluteal muscle per-formance may play an important role in low back pain. However, the ef-fects of lumbar manipulation on gluteal muscle activation is lacking. The purpose of this experiment was to generate pilot data for a future study which would analyze the immediate effects of lumbar spinal manipula-tion on gluteal muscle activation during functional activities. It was hy-pothesized that gluteal muscle activity would increase post0SMT in sub-jects with CLBP during the performance of functional tasks.NUMBER OF SUBJECTS: Three persons (2 men, 1 woman; ages 18, 40, and 18

years) with chronic non radicular LBP were recruited. Subjects were ex-cluded if they had spinal surgery, osteoporosis or a positive straight-leg-raise. Pain duration was 10, 4, and 0.5 years and Oswestry Disability score were 20%, 26%, and 26% disability.MATERIALS/METHODS: Prior to instrumentation, subjects practiced the 2 functional tasks: (1) step-up, (2) forward bending. The pace of each task was set using a metronome for 5 repetitions. The tasks were performed prior to and immediately following side-lying rotational lumbar thrust manipulation. To record gluteal activity and avoid crosstalk, intramus-cular electrodes were inserted into gluteus medius and maximus on the side of greatest low back pain. EMG signals were sampled at 2000 Hz and high-pass filtered at 10 Hz. The signal was smoothed with a root-mean-square using a 75-millisecond moving window. Onset and offset of the EMG signal for each repetition was visually determined with high reliability (ICC3,5 = 0.99 for each muscle). The average amplitude for the 5 repetitions was calculated for each task before and after the manipula-tion. Percent change [(mean RMS (post Rx) – mean RMS (pre Rx)/mean RMS (pre Rx)] was the dependent variable. Effect sizes were calculated.RESULTS: During the step-up, the change in EMG amplitude for gluteus medius in each subject was –50.7%, –0.7%, and –21%, and for the gluteus maximus –29.8%, –74.1%, and 1.6%, respectively. During forward bend-ing, the change in EMG amplitude for gluteus maximus in each subject was 13.9%, 30.0%, and 5.7%, respectively. Effect size for gluteus medius during step-up: –0.96; gluteus maximus: –0.90; forward bending, glute-us maximus: –0.71.CONCLUSIONS: This preliminary data suggests that SMT reduces gluteal muscle activation immediately following the manipulation. Further work in this area is warranted.CLINICAL RELEVANCE: These findings do not support the hypothesis that SMT may be effective due to its effect on gluteal muscle activation.

OPO21WHAT BIOPSYCHOSOCIAL FACTORS ARE DRIVING THE CLINICAL COURSE OF WHIPLASH: A CASE SERIESGiovanni Berardi, James M. Elliott, David M. WaltonDepartment of Physical Therapy, Presence St Joseph Medical Center, Joliet, Illinois; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; School of Physical Therapy, Western University, London, Ontario, CanadaBACKGROUND AND PURPOSE: Approximately 4 million individuals in the United States seek acute medical care for injuries following a motor ve-hicle collision (MVC) with indirect and direct costs ranging $30 to $100 billion per annum [3,4,11]. The majority of recovery is expected to occur within the first 3 months for nearly 50% of those injured. Recovery rates slow considerably after 3 months and nearly 25% of this group will have moderate to severe symptoms impacting their day-to-day life [1,2,5,6,7,8]. A number of biological and psychological factors have shown to influence recovery rates for whiplash-associated disorders (WAD) [2,13,14,15,16], but multidisciplinary management of such factors has made little advance of improving recovery rates for those approximately 25% with poor recov-ery [9,10]. Despite the challenges in managing whiplash, the landscape of prognostic-based studies is changing our understanding of recovery tra-jectories. Accordingly, a recently derived and validated clinical prediction rule (CPR) could assist the clinician by identifying factors contributing to each patient’s pain experience and thus potential for recovery [12]. The purpose of this case series is to (1) describe the application of the whiplash recovery CPR and (2) introduce a novel visual presentation of a triangula-tion method of pain assessment on a patient-by-patient basis.CASE DESCRIPTION: Twenty-three patients diagnosed with acute whiplash injury were examined and issued outcome measures at 3 time points: ini-tial evaluation, fourth visit, and discharge. Recorded measures included cervical AROM, P4 Instrument, Neck Disability Index (NDI), Impact of Event Scale-Revised (IES-R), Pain Catastrophizing Scale (PCS), and Self-


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Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS).OUTCOMES: Marked improvements were observed for total cervical AROM, P4 Instrument, NDI, IES-R, PCS, and S-LANSS at time of discharge. Group and individual patient data is presented with use of radar plots surveying pain from a biopsychosocial model.DISCUSSION: This case series provides preliminary data to support further formal investigation utilizing a biopsychosocial model for the assessment of pain in not only WAD, but other musculoskeletal disorders. The results provide a visual presentation of a triangulation method capturing the eti-ological factors of the heterogeneous WAD condition, providing the cli-nician with a detailed assessment of pain and disability to assist in deter-mining prognosis, implementing a plan of care, and monitoring recovery. Further research will survey other domains of pain processing; physio-logical, psychological, and social factors not assessed in this preliminary proof-of-concept study. Application of this assessment method in a busy clinical environment is dependent upon the ability to capture all known prognostic domains of a multifaceted condition. Such practice may allow the clinician to deliver individualized care that reduces pain and improves functional outcome on a patient-by-patient basis.REFERENCES: 1. Carroll LJ. Beliefs and expectations for recovery, coping, and depression in whiplash-associated disorders. Spine. 2011;36:S250-S256. 2. Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disor-ders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33:S83-S92. 3. CDC. Vital Signs: Health Burden and Medical Costs of Nonfatal Injuries to Motor Vehicle Occupants—United States, 2012. Available at http://www.cdc.gov/VitalSigns/crash-injuries. Accessed May 23, 2016. 4. CDC. WISQARS (Web-based Injury Statistics Query and Reporting System). Atlanta, GA: US Department of Health and Human Services; 2010. Available at http://www.cdc.gov/injury/wisqars. Accessed May 23, 2016. 5. Elliott JM, Kerry R, Flynn T, Parrish TB. Content not quantity is a bet-ter measure of muscle degeneration in whiplash. Man Ther. 2013;18:578-582. 6. Elliott JM, Noteboom JT, Flynn TW, Sterling M. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2009;39:312-323. 7. Elliott J, Pedler A, Kenardy J, Galloway G, Jull G, Sterling M. The temporal development of fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttrau-matic stress. PLoS One. 2011;6:e21194. 8. Elliott J, Sterling M, Noteboom JT, Treleaven J, Galloway G, Jull G. The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation. Eur Spine J. 2009:18:1371-1378. 9. Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M. Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain. 2013;154:1798-1806. 10. Lamb S, Gates S, Williams M, et al. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, 2-step, randomized controlled trial. Lancet Neurology. 2013;381:546-556. 11. Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traf Inj Prev. 2010:11(4):353-360. 12. Ritchie C, Hendrikz J, Jull G, Elliott J, Sterling M. External validation of a clinical prediction rule to predict full recovery and ongoing moderate/se-vere disability following acute whiplash injury. J Orthop Sports Phys Ther. 2015;45:242-250. 13. Sterling M, Jull G, Kenardy J. Physical and psy-chological factors maintain long-term predictive capacity postwhiplash injury. Pain. 2006;122:102-108. 14. Sterling M, Kenardy J. Physical and psychological aspects of whiplash: important considerations for prima-ry care assessment. Man Ther. 2008:13:93-102. 15. Sterling M, McLean SA, Sullivan MJL, Elliott JM, Buitenhuis J, Kamper SJ. Potential pro-cesses involved in the initiation and maintenance of whiplash-associated disorder. Spine. 2011;36:S322-S329. 16. Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, MacDermid JC, Gross A, Santaguida PL,

Carlesso L, ICON. An overview of systematic reviews on prognostic fac-tors in neck pain: results from the International Collaboration on Neck Pain (ICON) Project. Open Orthop J. 2013;7:494-505.

OPO22THE EFFECT OF DRY NEEDLING ON PAIN REDUCTION IN SUBJECTS WITH MYOFASCIAL TRIGGER POINTS IN THE UPPER TRAPEZIUS: A SYSTEMATIC REVIEWAnthony Bertrand, Kelsey Mastin, Bennett Rader, Matthew Standage, Tom SneedSouthwest Baptist University, Bolivar, MissouriPURPOSE/HYPOTHESIS: Due to sedentary lifestyles in today’s society, myofas-cial pain of the neck and shoulder region are commonly seen by physical therapists. This pain can be due to prolonged muscle activity which cre-ates muscle imbalance resulting in trigger point formation. Interventions for myofascial trigger points have been developing in recent years. Today, dry needling has become much more common to the point of potential-ly becoming part of foundational sciences in physical therapy. Since dry needling has become more common, physical therapists need to know: how effective dry needling is on pain reduction in patients with myofas-cial trigger points in the upper trapezius?NUMBER OF SUBJECTS: Two hundred thirty-six.MATERIALS/METHODS: Databases searched for relevant studies were CINAHL complete, MEDLINE, MEDLINE with Full Text, SPORTDiscus, Science Reference Center, Cochrane Central Register of Controlled Trials, and OVID. The searches used the key words “dry needling” and “upper trapezius.” The initial search resulted in 103 studies with a reduction to 53 studies after duplicates were removed. All 53 studies were screened by title and abstract resulting in 41 records being excluded due to addition-al treatments used in conjunction with dry needling or nonrelevant stud-ies associated with the topic. Full text analysis of the 12 remaining stud-ies led to 6 more studies excluded. The 6 included studies were assessed for level of research and strength of quality using an assessment tool by the American Academy for Cerebral Palsy and Developmental Medicine.RESULTS: Of the 6 studies analyzed, 4 were categorized as Level II random-ized controlled trials (RCT) while the remaining 2 were Level IV case se-ries. Two RCTs scored strong quality of 7/7 while the other 2 scored a moderate quality 4/7. The 2 case series scored a strong 6/7 and moder-ate 5/7. The quality of research was moderate to strong overall. The study results reveal dry needling decreases pain via Visual Analog Scale and Numeric Pain Rating Scale. Additionally, dry needling decreases subject perceived level of disability via Pressure Pain Threshold and Disabilities of the Arm, Shoulder, and Hand. The study results also reveal overall im-provement in mood and quality of life via Short Form Health Survey-36.CONCLUSIONS: It is clearly evident dry needling is beneficial at reducing pain in the upper trapezius muscle. Each study used some type of patient reported pain rating scale. The results of each study showed that pain rat-ings decreased, proving effectiveness of dry needling treatment for reduc-ing myofascial pain.CLINICAL RELEVANCE: Dry needling is an effective intervention for upper tra-pezius myofascial pain but has additional benefits as well. The interven-tion is less costly than other physical therapy treatments and is much less time consuming, taking only seconds to administer. Dry needling also has the potential to reduce the number of visits for a pain reduction benefit compared to other current interventions.

OPO23THE EFFECT OF DRY CUPPING AND EXERCISE ON LOW BACK PAIN AND RANGE OF MOTION: A CASE STUDYSteven B. Boswell, Alex Siyufy, Brent Harper, Adrian AronDoctor of Physical Therapy, Radford University, Roanoke, VirginiaBACKGROUND AND PURPOSE: Dry cupping (DC) is a noninvasive modality that is gaining popularity in the areas of massage and physical rehabilita-tion despite the scarce amount of research available. The most common


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indication for DC is musculoskeletal pain. Past studies have found that DC can decrease musculoskeletal pain in the neck and low back. Fewer studies have shown DC can decrease pain and increase range of motion (ROM). The purpose of the present case report is to determine the effects of DC and simultaneous exercise on low back pain and range of motion.CASE DESCRIPTION: The subject was a 24-year-old female that had been ex-periencing chronic recurring low back pain for greater than 2 months. The subject had limitations in multisegmental flexion and extension and experienced increases in pain with active ROM of the lumbar spine.OUTCOMES: For this case 4 cups were applied to the subject’s low back while prone and remained in place for 10 minutes. The cups were then removed and 4 cups were applied to the anterior thigh on each leg. Next, the subject performed knee flexion and extension in the seated position on each leg for 2 sets of 10. The cups were removed and another 4 cups were applied to the posterior thigh. The subject then performed 2 sets of 10 active straight leg raises (SLRs). The subject repeated the intervention every 2 days for a total of 3 treatments. A fourth follow-up session was scheduled a week later to reassess outcome measures. The following mea-sures were assessed prior to the first treatment and in the fourth follow-up session: Selective Functional Movement Assessment (SFMA) categori-zation for multisegmental flexion and extension, SLR passive ROM, Pain Pressure Threshold (PPT) for areas of the low back and lower extremity, and the Oswestry Disability Index (ODI). The numeric pain rating scale (NPRS) was also taken pre and post intervention for each session as well as the global rating of change (GROC) for the low back. In addition, the subjects worse NPRS rating for the low back over the past 7 days was tak-en. Notable changes include a 15° increase in left SLR PROM, a decrease in ODI score from 20% to 12%, a GROC increase of 3, notable increas-es in all PPT locations, and decreased NPRS scores. The subjects NPRS scores decreased after each treatment session and the NPRS at worst over the past 7 days also decreased from a 5/10 to a 3/10. The subject also re-ported 0/10 NPRS scores after treatment session 2 and 3 as well as in the fourth follow-up session. There were no changes in SFMA categories for multisegmental flexion or extension.DISCUSSION: In this case report, we examined the effects of DC in addition to exercise on low back pain and ROM. Overall, there were improvements any many of the outcome measures including pain, ROM, and PPT. To our knowledge, there are no studies examining the effects of DC with si-multaneous exercise for low back pain. Future studies are needed to test the protocol against a control on a large sample size.REFERENCES: 1. Emerich M, Braeunig M, Clement H, Lädtke R, and Huber R Mode of action of cupping—local metabolism and pain thresh-olds in neck pain patients and healthy subjects. Complement Ther Med. 2014;22,148-158. 2. Kim J, Lee M, Lee D, Boddy K, and Ernst E. Cupping for treating pain: a systematic review. Evid Based Complement Alternat Med. 2011:1-7. 3. Lauche R, Cramer H, Choi K, Rampp T, Saha F, Dobos G, Musial F. The influence of a series of 5 dry cupping treatments on pain and mechanical thresholds in patients with chronic nonspecific neck pain - a randomised controlled pilot study. BMC Complement Alternat Med. 2011;11:63. 4. Markowski, A., Sanford, S., Pikowski, J., Fauvell, D., Cimino, D., and Caplan, S. A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. J Alternat Complement Med (New York, NY). 2014;20:113-117. 5. Cao H, Li X, Yan X, Wang NS, Bensoussan A, and Liu J. Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials. J Trad Chin Med Sci. 2014;1:49-61. 6. Lauche R, Materdey S, Cramer H, Haller H, Stange R, Dobos G, Rampp T. Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain—a randomized controlled trial. PLoS One. 2013;8:1-9. 7. Rozenfeld E, Kalichman L. New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. 2016;20:173-178. 8. Tham L, Lee H, Lu C. Cupping: from a biome-chanical perspective. J Biomech. 2006;39:2183-2193.

OPO24STATIC AND DYNAMIC BALANCE DIFFERS BETWEEN INDIVIDUALS WHO ARE MIDDLE-AGED WITH AND WITHOUT CHRONIC LOW BACK PAINLucinda Bouillon, Eric Ondrus, Nathan Bylicki, Anthony BoyleRehabilitation Sciences, The University of Toledo, Toledo, OhioPURPOSE/HYPOTHESIS: Chronic low back pain (CLBP) has been found to reduce postural control and impair motor patterns. Balance deficits have also been associated with aging, as early as middle age. It is unclear if static or dynamic balance is affected by CLBP among individuals who are middle-aged. The purpose of this study was to assess static balance us-ing single-limb stance (SLS) and dynamic balance using Star Excursion Balance Test (SEBT) among individuals who are middle-aged with and without CLBP. Two hypotheses were tested: (1) static and dynamic bal-ance would be lower among individuals with CLBP compared to indi-viduals without CLBP, and (2) lower balance scores would be found on both dominant (D) and nondominant (ND) limbs among individuals with CLBP compared to people without CLBP.NUMBER OF SUBJECTS: Sixteen individuals with CLBP (age, 52.1 years) and 20 without CLBP served as controls (age, 48.9 years).MATERIALS/METHODS: Subjects were assigned a random order of tests (SLS versus SEBT) and limb (D versus ND). Limb dominance was identified as the preferred kicking limb. The SLS test was recorded in seconds for D and ND limbs. The SEBT used a composite score (sum of maximal ante-rior, posterolateral, and posteromedial directions divided by 3 times the leg length (LL) and multiplied by 100) for D and ND limbs, and record-ed as percent LL.RESULTS: The control group stood longer (53 seconds) compared to CLBP group (29 seconds) during SLS on only the ND limb (P = .001). The con-trol group obtained 88% LL compared to CLBP group (79% LL) during SEBT on only the D limb (P = .02).CONCLUSIONS: The hypotheses were partially accepted as the CLBP group had lower static and dynamic balance values compared to those without CLBP; however, the score differences were dependent upon which limb was tested.CLINICAL RELEVANCE: Individuals with CLBP perform static and balance tests with different motor-control strategies between limbs resulting in lower scores compared to the pain-free group. Thus, both limbs should be test-ed when using SLS and SEBT outcome measures since limb dominance appears to influence balance among middle-aged individuals with CLBP.

OPO25PHYSICAL THERAPY COMBINED WITH PROLOTHERAPY IN A RECREATIONALLY ACTIVE MIDDLE-AGED MAN WITH KNEE PAIN AND CHONDROMALACIA PATELLAKristin Bowne, Michael D. RossDepartment of Physical Therapy, Daemen College, East Amherst, New York; Physical Therapy, Scotts Valley, CaliforniaBACKGROUND AND PURPOSE: Recent evidence suggests that prolotherapy may be beneficial in patients with knee pain and osteoarthritis/chondro-malacia patella for decreasing pain and stiffness, and increasing strength, range of motion, and functional activity levels. However, the use of phys-ical therapy in combination with prolotherapy for patients with knee pain and chondromalacia patella has not been adequately described. Therefore, the purpose of this case report is to describe the use of physical therapy combined with prolotherapy in a recreationally active, middle-aged man with knee pain and chondromalacia patella.CASE DESCRIPTION: The patient was a 50-year-old male triathlete present-ing with a chief complaint of persistent left knee stiffness and antero-lateral knee pain. The patient’s symptoms began insidiously 9 months prior after an increase in his triathlon training activities. His knee pain progressed to the point that he could not perform any weight-bearing exercise without significant discomfort. Previous treatments included management by a physical therapist, as well as corticosteroid and hyal-


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uronic acid injections. Although these previous treatments provided min-imal benefit, the patient sought further management by another physical therapist. Physical examination findings at the time of the most recent physical therapist evaluation revealed an antalgic gait characterized by decreased stance phase on the left. Although knee range of motion was within normal limits, decreased patellofemoral joint mobility and patello-femoral joint crepitus and tenderness to palpation along the lateral aspect of the patella were noted. Quadriceps and hamstring muscle weakness was also noted. Ligamentous and meniscal testing was normal. Magnetic resonance imaging findings revealed moderate to severe chondromalacia at the lateral patellar facet.OUTCOMES: In addition to management by a physical therapist, the pa-tient received a series of 3 prolotherapy injections to the knee, each 3 to 4 weeks apart. Physical therapy management consisted of manual thera-py for lower quarter soft tissue and joint mobilization, targeted therapeu-tic exercise to address strength deficits of the quadriceps and hamstring muscles, and a gradual return to weight-bearing exercise and functional activity. At 4 months following the physical therapy and prolotherapy in-jections, the patient reported no pain during daily activities. Additionally, he had a normal gait, no complaints of stiffness, and full strength of the quadriceps and hamstrings muscles. Additionally, he had returned to swimming, cycling, unlimited walking and hiking on various surfaces, and agility drills.DISCUSSION: In patients with knee pain and chondromalacia patella, espe-cially those who have not responded to prior interventions, physical ther-apy combined with prolotherapy may serve as a treatment option.REFERENCES: Hauser RA, Sprague IS. Outcomes of prolotherapy in chon-dromalacia patella patients: improvements in pain level and function. Clin Med Insights Arthritis Musculoskelet Disord. 2014;7:13-20. Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L. Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolo-therapy for knee osteoarthritis. Arch Phys Med Rehabil. 2013;94:2075-2082. Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a random-ized controlled trial. Ann Fam Med. 2013;11:229-237. Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, Wu X, Ho RS, Wong SY. Hypertonic dextrose injections (prolotherapy) in the treatment of symp-tomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep. 2016;6:25247. Topol GA, Podesta LA, Reeves KD, Giraldo MM, Johnson LL, Grasso R, Jamà n A, Clark T, Rabago D. Chondrogenic effect of intra-articular hypertonic-dextrose (prolotherapy) in severe knee os-teoarthritis. PM R. In press.

OPO26IMPACT OF TOURING, PERFORMANCE SCHEDULE, AND DEFINITIONS ON 1-YEAR INJURY RATES IN PROFESSIONAL MODERN DANCERSShaw Bronner, Lily WoodADAM Center, New York, New YorkPURPOSE/HYPOTHESIS: This study augments recent analysis of injury rates over 15 years in a professional modern dance company. Time-loss in-juries (TLinj) averaged 0.16 injuries/1000-h exposure. Medical atten-tion injuries without time loss or injury report, defined as complaints, were not analyzed. Our objective was to examine the relationship be-tween touring, performance, rehearsal schedule and injury in this com-pany over 1 year in greater detail. This granularity may permit insight into the physical demands upon professional dancers.NUMBER OF SUBJECTS: Thirty-five dancers; 17 male (mean ± SD age, 29 ± 6 years).MATERIALS/METHODS: Prospective data for this company were recorded over 1 year, tracking new work-related musculoskeletal injuries (WMSI) involving an injury report, TLinj, complaints, diagnoses, and exposure hours. Injury data were excluded if sustained outside working hours, or defined as a re-injury occurring within 8 weeks of original diagnosis. The

year was divided up into 6 segments alternating with breaks approxi-mately 6 days. Injuries occurring during each segment were converted to injuries/1000-h dance exposure to allow comparisons of the effects of performance, rehearsal and travel. We conducted a quasi-Poisson analy-sis to determine differences between segments, sex, dance experience, co-varied with combined travel-performance days (P<.05).RESULTS: Twenty WMSI and 10 TLinj were sustained by dancers over 1 year: 0.44 WMSI and 0.22 TLinj/1000-h exposure. There were signifi-cant WMSI differences between segments but no differences due to sex or experience. WMSI were 6 times more likely to occur in Segment 6 (IRR = 6.033, P = .031), with 1.0 injuries/1000-h exposure. The highest rate of TLinj and traumatic injuries also occurred in segment 6 (0.57/1000 h). The greatest number of overuse injuries, 0.57/1000-h, were in segment 2, during an international tour. Although covariance with travel days was not significant, there was a moderate correlation between WMSI and travel days (r = 0.53). There was a ratio of 55%:45% trauma:overuse WMSI and 80%:20% TLinj over the year. Complaints/1000-h were fair-ly evenly distributed across segments as physical therapy hours were also consistent. The majority of WMSI and TLinj were muscle-tendon diag-noses, affecting the lower leg-Achilles and cervical areas.CONCLUSIONS: High rates of WMSI, TLinj and traumatic injuries in seg-ment 6 reflected a concentrated period of learning new choreography, 2 weeks NY season and 1 week travel/performance abroad without break. We attribute the large number of overuse injuries in segment 2 to raked stages encountered on tour. While tracking complaints permits under-standing of stressors to specific body regions and utilization of resources, WMSI and TLinj are the most important to track for injury surveillance.CLINICAL RELEVANCE: Time zones can affect sports performance however we have no method to quantify performance in dance other than injury. This may mask the effects of frequent travel on dancer’s well-being. Future studies will focus on the effect of travel on longer international tours.

OPO27THE NATURE OF MOVEMENT SYMMETRY: IMPLICATIONS FOR FUNCTION AND INJURY RISKLaura E. Broudy, Danny J. McMillian, Aerie Gloweeksa, Katie Schaner, Michelle WrigleyPhysical Therapy, University of Puget Sound, Tacoma, WashingtonPURPOSE: The purpose of this report is to identify movement asymmetries that negatively impact function or increase the risk for injury, and there-fore warrant physical therapy intervention.DESCRIPTION: Movement asymmetries can present in a variety of ways, in-cluding range of motion, force production, morphology and neuromus-cular control. Asymmetries might affect functional performance or injury risk. Quality of life might be negatively impacted for several reasons, such as loss of playing time in sports, inability to work, and decreased social participation. Currently there is limited evidence to identify which asym-metries negatively impact function and injury risk, and at what point physical therapy intervention would be beneficial. To aid in identifying such asymmetries, a review of the literature was completed. Sixty-nine peer-reviewed studies met the inclusion criteria and were analyzed for the effect of force production, mobility, and neuromuscular control asym-metries on functional performance and injury risk. Excluded were studies of neurological conditions, structural spinal conditions or leg length dis-crepancies, and studies that included prepubescent children.SUMMARY OF USE: There is strong evidence that supports the importance of symmetrical force production for optimal function and low inju-ry risk. However, there is inconsistent evidence on the degree of asym-metrical force that creates functional limitations or increased injury risk. Asymmetrical mobility is general defined as a side-to-side difference greater than 10%. However, some activities are inherently asymmetrical, and having those asymmetries is advantageous to function (eg, overhead throwing). The evidence suggests that sports such as soccer or basket-ball might demand more symmetry of the limbs, therefore side-to-side


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mobility differences are more likely to increase injury risk. The available research demonstrates that asymmetries in balance and neuromuscu-lar control are present in a variety of populations. The preponderance of evidence suggests that a lack of neuromuscular control and side-to-side asymmetry places the individual at an increased risk of injury, though tar-geted training has often proven to decrease such deficits, with subsequent decreases in the risk of injury. Trauma and several chronic conditions (eg, chronic ankle instability, anterior cruciate ligament rupture) are associat-ed with movement asymmetries and degeneration of affected joints.IMPORTANCE TO MEMBERS: A general trend in the literature revealed that LE asymmetries have a more pronounced negative impact on function and injury risk than UE asymmetries. Movement symmetry appears to be most important: (1) following injury to indicate readiness for return to sport, and (2) for tasks associated with bilateral weight bearing, since altered movement in 1 limb might transfer excessive stress to the other. Movement symmetry appears relatively less important when: (1) func-tional tasks demand asymmetrical patterns (eg, throwing, kicking sports), and (2) loads involved remain within the tissue tolerance.

OPO28AN INVESTIGATION OF FUNCTIONAL MOVEMENT IMPAIRMENTS IN YOGA PRACTITIONERS BEFORE AND AFTER YOGA POSTURE TRAINING AND WITH TARGETED EXERCISE INTERVENTIONSean A. Buchner, Brenda Boucher, Mandi FolgerPhysical Therapy, Texas State University, Austin, TexasPURPOSE/HYPOTHESIS: Movement impairments involve faulty movement patterns including abnormalities in posture and musculature. Spine and/or extremity deficits cluster to form movement impairments, which may result in mechanical breakdown over time. The study purpose was 3-fold: (1) investigate the extent to which common movement impairments were found in a group of asymptomatic yoga practitioners prior to participa-tion in an 8-week yoga training course, (2) assess the extent to which movement impairments initially identified changed upon completion of an 8-week yoga training course, and (3) assess response to a follow-up 6-week home exercise program (HEP) that addressed individual impair-ments of participants. Our study focused on the following movement im-pairments as described by Sahrmann: cervical extension rotation, scapu-lar depression and downward rotation, anterior glide and medial rotation of the shoulder, lumbar extension rotation, anterior glide and medial ro-tation of the hip and dominant hamstrings.NUMBER OF SUBJECTS: Twelve.MATERIALS/METHODS: Twelve subjects (3 male, 9 female; mean ± SD age, 28 ± 8.06 years). Inclusion criteria: greater than 18 years of age, great-er than 3 months of participation in yoga, registration and completion of an 8-week yoga training course, functional AROM and PROM in all ex-tremities, greater than 3 months without major injury, and no current spine abnormalities. Prior to initiation of an 8-week yoga training course, each participant was assessed using functional movements, and postur-al and muscular length/strength measurements. Identified deficits were placed into appropriate categories, ranked from 0 to 3 (0, absent; 3, se-vere). Assessment of movement impairments, defined and measured by Sahrmann, were performed for each participant prior to initiation and at completion of the training course.RESULTS: Movement impairments existed in all subjects prior to partici-pation in an 8-week yoga training course. At completion of the training course, re-assessment revealed significant increase in severity of move-ment impairments. Post 6-week individualized HEP, a significant de-crease in severity of movement impairments was found in all subjects.CONCLUSIONS: In the sample studied, movement impairments existed at a high rate among yoga practitioners, and the severity increased after par-ticipation in a yoga training course. The severity of movement impair-ments decreased among all subjects after a targeted exercise program.CLINICAL RELEVANCE: The study identified the presence of movement im-pairments in a regularly practicing yoga population and revealed an in-

creased severity of these impairments following an 8-week yoga training course. This indicates that yoga may enhance faulty movement patterns present in individuals who practice regularly. The results also support the clinical use of specific exercises that effectively treated the movement im-pairments addressed in this study.

OPO29ELECTROMYOGRAPHY ACTIVATION OF THE SHOULDER GIRDLE MUSCLES DURING ABDUCTION AT DIFFERENT BODY-ORIENTATION POSITIONSTraci A. Bush, Samantha Kotz, Oz Wolfensperger, Jordan Overland, David Stapleton, Vassilios VardaxisPhysical Therapy, Des Moines University, Des Moines, IowaPURPOSE/HYPOTHESIS: Muscle performance deficits are therapeutically ad-dressed via the use of resistance training [1,2]. Core components include frequency, intensity, time and type of exercise [2]. These components may be modified in different ways, including shifting the direction and rota-tional effect of gravity by altering the plane of motion [3]. This study as-sessed the effect of body position on muscle activation levels during shoul-der abduction. We hypothesized that the abduction muscle demands will be affected by position in terms of peak activation level and the coinci-dental joint angle.NUMBER OF SUBJECTS: Twelve.MATERIALS/METHODS: Subjects performed shoulder abduction to 100° in 4 positions: seated, side-lying, supine, and prone. Arm movement was monitored using 3-D motion capture. Muscle demand was assessed us-ing peak activation, in terms of percent manual muscle testing activation (percent MMT), and the coincidental shoulder joint angle. Surface EMG electrodes were placed on: posterior, middle, and anterior deltoid, upper trapezius, pectoralis major (sternal and clavicular), biceps brachii (long and short), triceps brachii (long), and latissimus dorsi muscles. Repeated measures ANOVA and paired t tests were used to test for significant dif-ferences between positions.RESULTS: The average abduction ROM across subjects and positions was 95.7° (93°-97.5°). The magnitude of activation (pooled across all deltoids and the trapezius) was modulated significantly (P = .001) by position, with higher demands in the seated and prone (65% ± 13% MMT) ver-sus the side-lying and supine (24% ± 8% MMT) positions. The abduction task imposed significantly higher demands on the posterior deltoid (26% MMT more) in prone and on anterior deltoid in seated and supine (22% and 21% MMT more, respectively). The upper trapezius showed signifi-cant (P = .001) progressive activation across positions (13%, 27%, 66%, and 82% MMT) for side-lying, supine, prone, and seated, respectively. There were significant differences in the activation of both pectoralis por-tions between positions (9.5% MMT, P = .01) as well as between both heads of the biceps at different positions (P = .05). The triceps and the la-tissimus dorsi showed higher activation (P = .01) in prone (33% and 23% MMT, respectively). The peak activation coincidental joint angle was also different amongst the different positions.CONCLUSIONS: The change of plane of motion provided a significant mod-ulation on muscle activation demands and offers the ability to focus load-ing on an identified muscle or group of muscles, aiming at the improve-ment of muscle performance and/or the reduction of muscle imbalances [3,4]. Depending on the rehabilitation goals the change in the gravita-tional direction can progress the therapeutic exercise protocol from as-sisted to active, and thus facilitate the tissue healing process [2,4,5].CLINICAL RELEVANCE: During examination, diagnosis and therapeutic exer-cise protocol development focusing on rehabilitating an injured joint or strengthening a muscle, it is imperative to modulate the level of activation and excursion of the muscle.

OPO30WHAT ARE THE ODDS? A SERIES OF SPINE REFERRALS IN RESIDENCY TRAINING: A CASE SERIESBethany Buzzell


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Department of Physical Therapy and Occupational Therapy, Duke University Medical Center, Durham, North CarolinaBACKGROUND AND PURPOSE: The decision-making ability of physical ther-apists in evaluating whether management by a physical therapist or re-ferral to another medical professional is appropriate is well documented. Jette et al concluded that physical therapists were able to make correct decisions for patients with musculoskeletal and critical medical condi-tions, however the results suggested that there is a “need for further em-phasis on education in medical screening, identification of red flag symp-toms, and differential diagnosis.” The purpose of this case series is to highlight the identification of 3 spine cases for medical referral and the value of careful analysis of clinical reasoning strategies during special-ty training.CASE DESCRIPTION: The prevalence of serious spine pathology from a co-hort of patient’s seeking primary care treatment for low back pain has been documented to be .9%. In the first 3 months of orthopaedic resi-dency training, 6% of evaluations performed were diagnosed for medical referral. The examination of 3 of these noncritical medical referrals were analyzed due to the discrepancy in odds. All 3 patients were initially re-ferred to a hospital-based outpatient physical therapy clinic from physi-cians who specialized in the spine.OUTCOMES: Pretest probabilities were estimated from prevalence statistics. Clinical reasoning strategies were evaluated, and the diagnostic accuracy of subjective data and clinical findings were applied to calculate the post-test probability of pathology. Patient outcomes and appropriateness of re-ferral for the 3 case examples are described.DISCUSSION: Successful noncritical medical referral was demonstrated in these 3 patients. This case series highlights the analysis of red flag screen-ing and the use of a consistent management model in differential diag-nosis of the spine. When used in isolation, red flags have little diagnostic value. It is imperative for physical therapists to implement best-evidence strategies to appropriately screen for these pathologies so as to avoid un-necessary investigations that are themselves harmful. Despite the odds, utilizing the diagnostic accuracy of test findings to reflect back on these cases demonstrated that the clinical decision-making was consistent with what was diagnosed on imaging. This series highlights the values of re-flective clinical practice with red flag screening for residency or fellow-ship education.REFERENCES: 1. Ross M, Boissonnault W. Red flags: to screen or not to screen? J Orthop Sports Phys Ther. 2010;40: 682-684. 2. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prevalence of and screening for serious spinal pa-thology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60:3072-3080. 3. Hegedus E, Stern B. Beyond SpPIN and SnNOUT: considerations with dichotomous tests during assessment of diagnostic accuracy. J Man Manip Ther. 2013;17:E1-E5. 4. Cook C, Brown C, Isaacs R, Roman M, Davis S, Richardson W. Clustered clinical findings for diagnosis of cervical spine myelopathy. J Man Manip Ther. 2010;18:175-180. 5. Guss D, Smith J, Chiodo C. Acute Achilles tendon rupture: a critical analysis review. BJS Rev. 2015;3:e2.

OPO31VALIDATION OF SMOOTH-PURSUIT NECK TORSION AND SEATED CERVICAL TORSION TESTS FOR THE DIAGNOSIS OF CERVICOGENIC DIZZINESS: A SYSTEMATIC REVIEW OF THE LITERATUREJanet Callahan, Marianne Beninato, Makinde O. Olufisayo, Urvashi MehtaPhysical Therapy, MGH Institute of Health Professions, Boston, MassachusettsPURPOSE/HYPOTHESIS: Due to the lack of a gold standard diagnostic test, cervicogenic dizziness (CGD) remains a controversial entity. Nevertheless, use of certain clinical tests are recommended in the literature for deter-mining a clinical diagnosis of CGD. Two of these tests are the smooth pursuit neck torsion test (SPNTT) and the seated cervical torsion test

(SCTT). The quality of the evidence for the diagnostic validity of these clinical tests has not been systematically analyzed. The purpose of this study was to evaluate the quality of literature on the diagnostic psycho-metric properties of these tests to diagnose CGD.NUMBER OF SUBJECTS: Five studies were analyzed.MATERIALS/METHODS: Search of PubMed, CINAHL and Google Scholar was conducted. Articles were included if (1) they were clinical or laborato-ry validation studies on the diagnostic test properties of the SPNTT and SCTT (2) the primary diagnostic group as patients with dizziness or verti-go of cervical origin with whiplash associated disorders, cervical dysfunc-tion, chronic neck syndromes or cervical degenerative disorder with or without pain and (3) published in English from June 1992 to April 2015. Studies were excluded if they were validation studies where the primary diagnostic group was patients with headaches, vertigo of known origin, benign paroxysmal positional vertigo, or cerebral vascular disease. The quality of the identified diagnostic studies was assessed using version 2 of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) scale. Study design was rated based on the risk of bias and the applicabil-ity to a diagnostic patient group or condition across 4 major domains: (1) patient selection, (2) index test, (3) reference standard and (4) the flow and timing of the administration of tests. Bias and applicability concerns were rated as “low,” “high” or “unclear” for each domain.RESULTS: Five studies examined the validity of the SPNTT and 1 also ex-amined the SCTT. Most studies (3/5) compared people with suspected CGD to people with other nonCGD confirmed clinical diagnoses, there-by introducing bias that likely inflated the diagnostic accuracy of the in-dex test. All 5 studies used instrumented laboratory measure of smooth pursuit gain as the index test. Most (3/5) papers were rated as “high” risk for bias on patient selection and all papers were at “high” risk for choice of reference standard. The majority of papers had “high” concern that the findings were not applicable to all people with CGD due to flaws or in-consistencies in patient selection, and index test or reference standard applications.CONCLUSIONS: A lack of robust validity of these tests, even as instrumented in the laboratory setting, renders these tests of questionable value as di-agnostic tools for CGD.CLINICAL RELEVANCE: Results from studies of instrumented versions of these tests should not be generalized for noninstrumented clinical use. Noninstrumented versions of these tests have never been validated thus, their clinical use for the diagnosis of CGD is not recommended.

OPO32EVIDENCE BASED TREATMENT ALGORITHM FOR PATIENTS WITH A DIAGNOSED CONCUSSION: CASE STUDYJames Camarinos, George PadinPhysical Therapy, Boston University, Allston, MassachusettsBACKGROUND AND PURPOSE: The management of concussion injuries re-mains controversial, in particular decisions on when and how to inter-vene with targeted therapies and when rest is less beneficial than activi-ty. Furthermore, specific examination and treatment descriptions are not readily available in many sources. There is growing evidence in utilizing a system-based classification in treating the somatic symptoms of con-cussion and postconcussion syndrome. The purpose of this paper is to highlight the decision making process and subsequent treatment based on system subgroups of concussion in 2 patients presenting with a simi-lar mechanism of injury with different courses of treatment.CASE DESCRIPTION: Two patients, both 3 weeks postconcussion were re-ferred to an outpatient private practice. Both individuals presented with a similar mechanism of concussion injury.OUTCOMES: Pain was assessed using a numeric pain rating scale (NPRS), symptom type and severity was measured by the Post Concussion Symptom Scale (PCSS), activity limitation was assessed using the Patient-Specific Functional Scale (PSFS), vestibular dysfunction was measured using the Vestibular/Ocular-Motor Screen (VOMS), and cardiovas-


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cular/physiologic response to exercise was assessed using the Buffalo Concussion Treadmill Test (BCTT). A cervical spine exam was complet-ed on both patients as well. Patient 1 presented with convergence def-icits and limited cardiovascular/physiologic response to exercise, while patient 2 presented with more gaze stability deficits, cervical hypomobil-ity associated with headaches, visual motion sensitivity, and limited car-diovascular response to exercise. Physical therapy was tailored to the spe-cific pathophysiological dysfunctions for each patient. After 4 visits each, both patients displayed a decrease in NPRS values by at least 4 points, decrease in PCSS scores by at least 50%, an improvement in PSFS by at least 5 points, and at least a 15 bpm heart rate improvement on the BCTT. Vestibular function for patient 1 improved as documented by a decrease in near point convergence distance by 4 cm and 0/10 score on the symptomatic VOMS scale for convergence. Vestibular function for pa-tient 2 improved as documented by a 40 bpm increase in VOR X1 view-ing and 0/10 score on the symptomatic VOMS scale for Visual Motion Sensitivity. Cervical mobility for patient 2 normalized and no longer re-produced headache with active motion.DISCUSSION: Pain, symptom response, vestibular function, and cardiovas-cular/physiologic response to exercise all improved in both patients after 4 visits of tailored physical therapy using a system-based classification ap-proach. Functional evidence of this improvement was noted on the sig-nificant activity improvement made in the PSFS for each patient. The im-pairment and activity improvement noted across both patients indicates that a symptom-based classification approach has the potential to pro-duce positive treatment effects and facilitate return to play time in ath-letes with persistent symptoms after sustaining a concussion.REFERENCES: 1. Ellis MJ, Leddy JJ, Willer B. Physiological, vestibulo-ocular and cervicogenic postconcussion disorders: an evidence-based classifica-tion system with directions for treatment. Brain Inj. 2015;29:238-248. 2. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Craniovestibular rehabilitation in sport related concussion: a randomised control trial. Br J Sports Med. 2014;48:1294-1298. 3. Mucha A, Collins MW, Elbin RJ, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) assess-ment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42:2479-2486. 4. Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of concussion and postconcussion syndrome. Sports Health. 2012;4:147-154. 5. Marshall CM, Vernon H, Leddy JJ, Baldwin BA. The role of the cervical spine in postconcussion syndrome. Phys Sportsmed. 2015;43:274-284.

OPO33THE CLINICAL MANAGEMENT OF SHOULDER PAIN AND THE SICK SCAPULA IN THE FEMALE OVERHEAD ATHLETE: A CASE SERIES REPORTTaryn E. Cappadona, Dale Yake, Zachary E. Walston, Carlos JohnsonPT Solutions, Smyrna, GeorgiaBACKGROUND AND PURPOSE: The prevalence of shoulder injuries in the over-head athlete is on the rise, with an estimated 30% of athletes incurring documented shoulder injuries at some point in their athletic career. There have been a multitude of studies looking at shoulder pain in athletes, with the primary focus on baseball players. The purpose of this case series was to evaluate effective treatment strategies geared toward the female over-head athlete in a variety of settings. Specifically, this study addresses the female overhead athlete presenting with a resting malposition of the scap-ula known as SICK scapula, in addition to pain with participation in their respective sport.CASE DESCRIPTION: The study looked at 3 young female athletes, partici-pating in track and field, tennis, and softball. Methods include use of a specialized protocol with 4 main phases. The first phase focuses on im-proving neuromotor control of the scapula, reducing pain, and muscular endurance. The second phase, the intermediate phase, addresses muscle imbalances of the upper quarter as well as capsular mobility. The third phase is the advanced phase, in which the athlete begins higher level

sport-specific drills. The final phase is return to sport.OUTCOMES: Patients were treated 2 to 3 times per week for 12 weeks. Using this protocol, all 3 of the female athletes had a full reduction in symptoms, demonstrated normalized scapular positioning with overhead activities, and were able to have a full return to sport.DISCUSSION: The overall results of this study suggests that further research is needed in this area of physical therapy in order to draw any definitive conclusions.REFERENCES: Wilk K, Obma P, Simpson II C, et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther. 2009;39:38-54. Lawrence R, Braman J, Laprade R, Ludewig P. Comparison of 3-dimensional shoul-der complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J Orthop Sports Phys Ther. 2014;44:636-645. Lawrence R, Braman J, Staker J, et al. Comparison of 3-dimensional shoulder kinematics in in-dividuals with and without shoulder pain, part 2: glenohumeral joint. J Orthop Sports Phys Ther. 2014;44:646-655. Postacchini R, Carbone S. Scapular dyskinesis: diagnosis and treatment. OA Musculoskelet Med. 2013;1:20. Burkhart S, et al. The disabled throwing shoulder: spectrum of pathology part iii: the sick scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641-661. Shanley E, Thigpen C. Throwing injuries in the adolescent athlete. Int J Sports Phys Ther. 2013;8;630-640. Wilk K, Macrina L, Reinold, M. Non-operative reha-bilitation for traumatic and atraumatic glenohumeral instability. N Am J Sports Phys Ther. 2006;1:16-31.

OPO34EFFECTS OF VIDEO AND VERBAL AUGMENTED FEEDBACK ON JUMP-LANDING ERRORJoe G. CarpenterPhysical Therapy, Winston Salem State University, Gibsonville, North CarolinaPURPOSE/HYPOTHESIS: Augmented external feedback, by visual, video re-view and oral instruction have been shown to improve jump-landing technique immediately following jump-landing trials and when retest-ed (without any interventions) 1 week later. This study analyzed whether augmented feedback provided over an extended period of time improved jump-landing errors.NUMBER OF SUBJECTS: Fifteen (mean ± SD age, 23.5 ± 1.2 years).MATERIALS/METHODS: Subjects were assigned to 1 of 3 groups: A (no feed-back), B (verbal feedback), or C (iPad video and verbal feedback) for sep-arate analysis on feedback. On day 1, all subjects completed a baseline jump-landing test, a jump landing training session, and an initial jump-landing posttest. In all testing sessions (baseline, initial posttest, final posttest), and training sessions subjects completed 3 practice jumps fol-lowed by 5 recorded jumps. For baseline testing, initial post testing, and final post testing kinetic and kinematic data were collected using Qualisys 3-D motion capture systems and AMTI force plates. During jump train-ing sessions, data were collected on 2 iPads and scored using the Landing Error Scoring System (LESS), a clinical assessment tool of jump-land-ing biomechanics. Following day one, each subject participated in a jump training session once a week for 3 consecutive weeks. During jump train-ing sessions, subjects in groups B were given 2 verbal cues correlating to 2 errors the researcher believed were most prominent upon reviewing LESS found the video footage prior to feedback. Those in group C were given verbal feedback similar to group B while viewing the video on the iPads. Subjects completed a final jump-landing posttest 2 weeks after the last jump training session. A time (pre, post, final) by group (A, B, C) mixed ANOVA was performed.RESULTS: No significant differences were found between groups for any of the dependent variables using a repeated measures ANOVA. Over train-ing sessions, the control group showed little improvement on the LESS (average decrease of 0.4 errors), the verbal feedback group improved slightly (average decrease of 1.6 errors), and video and verbal group im-


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proved the most (average decrease of 3.0 errors). For kinetic and kine-matic data, all sagittal plane data (knee and hip flexion) and ground re-action forces relative to body weight improved for the video and verbal group over testing sessions. Video and verbal group improved more than both the control and verbal only groups in all sagittal plane and ground reaction force data.CONCLUSIONS: Although not significant, subjects showed improvements in jump-landing error using video and verbal feedback over an extended period of time. Further studies with larger sample sizes need to be con-ducted to understand the best means of feedback for decreasing risk of ACL injury.CLINICAL RELEVANCE: This study examines different means of feedback for jump landing analysis that can be used in a clinical setting. With new and evolving technologies, clinicians should be aware of the efficacy of differ-ent mechanisms for feedback.

OPO35VALIDATION OF LIMB-LOADING SYMMETRY USING WEARABLE PLANTAR PRESSURE INSERTS: APPLICATION FOR MONITORING OF DAILY LOADINGMing-Sheng M. Chan, Emily Hernandez, Susan SigwardBiokinesiology and Physical Therapy, University of Southern California, Pasadena, CaliforniaPURPOSE/HYPOTHESIS: Persistent loading asymmetry following anterior cru-ciate ligament reconstruction (ACLR) is a concern as it is thought to con-tribute to increase risk for re-injury [1-7]. Daily loading behaviors outside of formal rehabilitation may provide a strong stimulus to reinforce asym-metrical loading patterns during early recovery [8]. However, how indi-viduals load their limbs throughout the day is not known. Recent advanc-es in wearable technology may provide a mechanism for quantifying limb loading outside of a laboratory setting. The purpose of this study was to de-termine the level of agreement between force platforms and wearable pres-sure inserts for measurements of loading symmetry during daily activities.NUMBER OF SUBJECTS: Seven healthy individuals (3 male) participated.MATERIALS/METHODS: Participants performed single limb stance, sit-to-stand, stand-to-sit, and walking and a combined sit-to-stand, turning, walking and stooping tasks. Data were collected concurrently from force platforms (BTS, Milan, Italy; 1000 Hz) and shoe insert equipped with 8 pressure sensors positioned across the heel, midfoot, forefoot and toes (Orpyx, Calgary, Canada; 100 Hz). Vertical ground reaction force (vGRF) impulse was calculated from force platforms as the area under vGRF time curve for each condition. Vertical force (vF) impulse was calculated from shoe inserts. Total force from pressure sensors (PSI) was multiplied by sensor area (mm2) for each sensor and summing the forces from 8 sen-sors. Total force measured during a single limb stance task was used to normalize forces measured during all other experimental tasks (%BW). vF impulse was calculated as the area under the total force (% BW) time curve for each task. Symmetry indices were calculated as a ratio of non-dominant/dominant for vGRF and vF impulses. Averages of 5 symmetry indices per task per person for vGRF and vF were considered for analyses. To quantify the level of agreement between systems, concurrent validity of was determined using intraclass correlation coefficients (ICC3,k) analyses were performed individually on each task.RESULTS: Symmetry indices of vGRF and vF impulse ranged from vGRF: 0.03-0.19; vF: 0.05-0.17 across tasks. ICCs were 0.88 (P = .011) for sit-to-stand, 0.84 (P = .021) for stand-to-sit, 0.93 (P = .003) for walking, and 0.88 (P = .01) for continuous task.CONCLUSIONS: ICCs greater than or equal to 0.88 indicate a high level of agreement between measurement systems for calculation of limb loading symmetry in healthy individuals during tasks that represent daily activi-ties. The level of asymmetry between limbs measured with the gold stan-dard force platforms ranged from 3% to 20%. The strong concurrent va-lidity with relatively small asymmetries suggests these shoe sensors will be capable of quantifying between limb loading deficits in individuals fol-lowing ACLR.

CLINICAL RELEVANCE: Wearable pressure inserts may provide valuable in-formation for quantification of loading behaviors in individuals follow-ing ACLR in a daily basis.

OPO36THE EFFICACY OF INSTRUMENTED ASSISTED SOFT TISSUE MOBILIZATION: A SYSTEMATIC REVIEWScott W. Cheatham, Morey J. Kolber, William J. Hanney, Paul SalamhCalifornia State University Dominguez Hills, Torrance, California; Nova Southeastern University, Fort Lauderdale, Florida; Physical Therapy, University of Central Florida, Orlando, Florida; Duke University, Durham, North CarolinaPURPOSE/HYPOTHESIS: Instrument assisted soft-tissue mobilization (IASTM) is a popular intervention for musculoskeletal pathology. Several types of in-struments and approaches exist. Despite popularity, a consensus on the op-timal IASTM approach has not been identified in the literature. Moreover, a paucity of research exists to establish a consensus for the efficacy of IASTM. Thus, a systematic review of the current evidence assessing the ef-fects of IASTM as an intervention for musculoskeletal pathology or to en-hance joint range of motion (ROM) was conducted.NUMBER OF SUBJECTS: None.MATERIALS/METHODS: A systematic search strategy was conducted ac-cording to the Preferred Reporting Items for systematic reviews and meta-analyses (PRISMA) guidelines. The following databases were searched during the month of December 2015: PubMed, PEDro, Science Direct, and EBSCOHost collection. The search terms included individual or a combination of the following: instrument assisted augmented soft-tissue mobilization Graston and technique. Studies considered for inclu-sion met the following criteria: (1) peer reviewed, English language pub-lications; (2) controlled clinical trials that compared pretest and posttest measurements for an intervention program using IASTM; (3) studies that compared an intervention program using IASTM; (4) studies that com-pared 2 intervention programs using IASTM. Studies were excluded if they were non-English publications, clinical trials that did not directly measure the effects of IASTM, clinical trials that included Gua Sha and ASTYM, case reports, clinical commentary, dissertations, and conference proceedings. Two reviewers participated in the review and agreed upon articles retained and excluded.RESULTS: A total of 7 randomized controlled trials were appraised. Five studies measured an IASTM intervention versus a control or alternate intervention. The results of the studies showed improvement, albeit no significant difference between the groups (P>.05) for pain, function, strength, muscle length, and balance. Two studies measured an IASTM intervention versus a control or alternate intervention group on the ef-fects of joint ROM via the effect of muscle length. The IASTM interven-tion produced significant (P<.05) short-term gains up to 24 hours.CONCLUSIONS: The literature measuring the effects of IASTM is still emerging. The consensus of current research suggests favorable results of IASTM as a treatment for common musculoskeletal pathology, how-ever, the results are not superior to other interventions such as soft tis-sue mobilization or stretching. Among asymptomatic individuals there appears to be supportive evidence for IASTM as an intervention to in-crease short-term joint ROM with a superior effect compared to a con-trol group (P≤.001).CLINICAL RELEVANCE: IASTM may be an effective intervention for improv-ing joint ROM among healthy and injured individuals, however, the effi-cacy of this intervention for treating individuals with musculoskeletal pa-thology is not superior to alternative interventions.

OPO37RELIABILITY OF A PRESSURE PAIN THRESHOLD SCALE: A PRELIMINARY INVESTIGATIONScott W. Cheatham, Morey J. Kolber, William J. Hanney,


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Monique MokhaKinesiology, California State University Dominguez Hills, Carson, California; Exercise and Sports Science, Nova Southeastern University, Davie, Florida; Physical Therapy, Nova Southeastern University, Davie, Florida; Physical Therapy, University of Central Florida, Orlando, FloridaPURPOSE/HYPOTHESIS: Manual palpation for tenderness is an examination technique used to identify tissue reactivity, quantify severity, and assist with the diagnosis of musculoskeletal conditions. Chronic conditions such as fibromyalgia (FM) depend on the palpation examination for diagnosis since imaging and blood tests are inconclusive. Despite the widespread use of manual palpation, a consensus for reliably documenting and quan-tifying pressure pain thresholds (PPT) does not exist. An ordinal scale, possessing reliability, that quantifies palpable tenderness would serve use-ful for identifying tissue reactivity, documentation of change, and assist with the clinical diagnosis. Thus, the purpose of this study was to deter-mine the intrarater reliability of a 5-point ordinal scale (graded 0-4 with increasing severity) that may be used for identifying and quantifying pal-pable tenderness.NUMBER OF SUBJECTS: Twenty participants (mean ± SD age, 43.81 ± 15.0 years) including 10 diagnosed with FM (2 male, 8 female) and 10 con-trols (4 male, 6 female) with no known orthopaedic pathology were re-cruited for this study.MATERIALS/METHODS: Participants underwent a testing session using the American College of Rheumatology tender point criteria for the diagno-sis of FM. The 18 predetermined tender points were selected as they are established areas of palpable tenderness, thus allowed assessment of the full range of the 5-point scale. For each tender point, the examiner grad-ed the response using the scale (0, no tenderness; 1, reports tenderness; 2, reports tenderness and has facial expression; 3, withdraws; 4, does not al-low palpation beyond superficial contact). The session was repeated with-in 3 days. Pressure up to 4 kg/cm2 was applied at each tender point using the thumb with a digital pressure algometer. Testing stopped once the ex-aminer reached 4 kg/cm2 of pressure or once a maximum level of pressure was reported by the patient. Algometry is a well-accepted instrument for quantifying PPT. Intrarater reliability for all 18 tender points was calcu-lated using the intraclass correlation coefficient (ICC) model 3,k.RESULTS: The ordinal scale had good intrarater reliability with the FM (ICC = 0.92; CI: 0.89, 0.94) and control group (ICC = 0.91; CI: 0.88, 0.93).CONCLUSIONS: The results provide preliminary evidence of reliability for an ordinal scale that may be used for quantifying palpable tenderness. Future research should determine the diagnostic accuracy of the PPT scale as well as the minimum threshold cut point to determine tender-ness associated with pathology.CLINICAL RELEVANCE: The development and utilization of a reliable PPT scale may have clinical applications for identifying tissue reactivity, quan-tifying tenderness, documenting change, as well as assisting with the clin-ical diagnosis.

OPO38EXAMINATION OF BOTH LANDINGS BEFORE AND AFTER 4 WEEKS OF JUMP-LANDING TRAININGSusan A. Chinworth, Tyler Cope, Srikant Vallabhajosula, Joe G. CarpenterPhysical Therapy Education, Elon University, Elon, North Carolina; Winston-Salem State University, Winston-Salem, North CarolinaPURPOSE/HYPOTHESIS: Errors in vertical jump landing techniques are asso-ciated with increased knee injury. Verbal and visual training techniques are used to help correct these errors. However, assessment and correc-tion of errors are often recommended for only the first jump not the sec-ond jump. Recent evidence suggests that the second landing should be assessed but the information was only applied to a one-time testing ses-sion with no long-term training provided. The purpose of this study was

to examine the biomechanics of both landings before and after 4 weeks of training with multiple forms of feedback.NUMBER OF SUBJECTS: Fifteen (mean ± SD age, 23.5 ± 1.2 years).MATERIALS/METHODS: Subjects were randomly assigned to 1 of 3 groups (Gpr): A (control-no feedback), B (verbal feedback), or C (iPad video+verbal feedback). All subjects completed an initial jump-landing rebound pre-test followed by a jump training session. Subjects completed weekly jump-landing training sessions for 4 weeks. A week following the final training session, posttesting was done with the same methods as pretest. Subjects landed onto 2 force plates from a 30-cm-high box such that 1 foot hit each plate. Upon landing they immediately rebounded for a maximal vertical jump and a second landing onto the force plates. After practice, 5 jump tri-als were recorded. Peak vertical ground reaction forces normalized to body weight (Fz), hip, knee and ankle joint angles at initial plate contact (IC) and joint excursions (ROM) were analyzed as first-second landing ratios. Training sessions consisted of 3 practice jumps and 5 trial jumps with feed-back given twice within each session. Verbal feedback provided to the Grp B and C focused on 2 errors that the researchers believed were most promi-nent in reviewing the video footage between jumps. Grp C was also provid-ed with video feedback. A time (pre, post)-by-group (A,B,C) mixed ANOVA was performed.RESULTS: Fz ratios ranged from 1.03 ± 0.18 (Grp B; pre) to 1.31 ± 0.41 (Grp B; post). There was a trend towards significant interaction (P = .055) be-tween pre and posttesting and groups (1.22-1.18; 1.04-1.3; 1.12-0.96; pre-post and groups A, B and C, respectively). There was a significant main ef-fect (P = .048) for the knee flexion ratio at IC with ratios less than 1 for A and B but 1.97 for C. There was also a significant main effect of time (pre-post) for ankle sagittal joint excursion (P = .017) with ratios 1.16 (pre) and 1.07 (post) regardless of group.CONCLUSIONS: The differences in ratios for different variables, groups and testing sessions findings indicate that the second landing should be con-sidered when examining vertical jump and/or rebound landing tech-niques. As the findings were consistent across training groups, both land-ings should be examined when training activities are utilized.CLINICAL RELEVANCE: Jump landings are being used clinically with assess-ment tools to determine risk of knee injury. Often the second landing is ei-ther ignored or not assessed similarly to the first. This study supports that the second landing be examined when training sessions are performed.

OPO39EXAMINATION OF FIRST AND SECOND LANDINGS OF DROP JUMPS WITH A SINGLE SESSION OF JUMP-LANDING TRAININGSusan A. Chinworth, Srikant Vallabhajosula, Tyler Cope, Joe G. CarpenterPhysical Therapy Education, Elon University, Elon, North Carolina; Winston-Salem State University, Winston-Salem, North CarolinaPURPOSE/HYPOTHESIS: Analyses of vertical jump and rebound landing tech-niques are used to identify and decrease risk of knee injury. Techniques are generally examined only for the first landing although 2 landings are involved in these jumps. Recent evidence suggests that the second landing should also be assessed but the findings were only applied to a one-time testing session with no training performed. Therefore, the purpose of this study was to examine the kinematics and kinetics of both landings before and after a single training session with augmented feedback.NUMBER OF SUBJECTS: Fifteen (mean ± SD age, 23.5 ± 1.2 years).MATERIALS/METHODS: Subjects were randomly assigned to 1 of 3 groups (Grp): A (control-no feedback), B (verbal feedback), or C (iPad video+verbal feed-back). All subjects completed: jump-landing rebound pretest, jump train-ing session, and jump-landing rebound posttest within 1 day. Subjects land-ed onto 2 force plates from a 30-cm-high box such that 1 foot hit each plate. Upon landing they immediately rebounded for a maximal vertical jump and a second landing onto the force plates. After practice, 5 jump trials were re-corded. Data were collected using Qualisys Motion Capture System and an-


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alyzed using Visual3D software. Peak vertical ground reaction forces nor-malized to body weight (Fz), hip, knee and ankle joint angles at initial plate contact (IC) and joint excursions (ROM) were analyzed as first-second land-ing ratios. The training session consisted of practice jumps and 5 trial jumps with verbal feedback given to Grp B and verbal+video feedback to Grp C. A time (pre, post)-by-group (A,B,C) mixed ANOVA was performed.RESULTS: There were no significant interaction and main effects for Fz ra-tios, angles at IC and joint excursions. However, there was a trend to-wards significance for Time main effect for knee ROM ratio (P = .064). Subjects had more similar knee ROM during post (1.01 ± 0.05) compared to pre (1.06 ± 0.04). Fz ratios ranged from 1.04 ± 0.16 (Grp B; pre) to 1.3 ± 0.17 (Grp A; post) and slightly increased from pre-to-post testing (1.2-1.3; 1.04-1.18; 1.12-1.13 for Grp A, B, and C, respectively). Ratios for sagittal angle joint excursion, were mostly around 1. Ratios for sagittal plane an-gles at IC ranged from 0.96 (Knee Grp C; pre) to 5.4 (Ankle Grp C; pre). There was more variability in the hip and knee frontal plane ratios with range of 0.33 (Knee Grp B; post) to 2.9 (Hip Grp B; pre).CONCLUSIONS: The near 1:1 ratios for Fz and sagittal plane angles as well as variability seen in knee and hip frontal plane angles indicate that the second landing should be considered when examining vertical jump and/or rebound landing techniques. As the findings were consistent across training groups, both landings should be examined when training activi-ties are utilized.CLINICAL RELEVANCE: Jump landings are being used clinically with assess-ment tools to determine risk of knee injury. Often the second landing is either ignored or not assessed in the same manner as the first. This study supports that the second landing be examined regardless if the assess-ment is one-time or with training sessions.

OPO40THE ASSOCIATION OF PHYSICAL ACTIVITY WITH OUTPATIENT PHYSICAL THERAPY UTILIZATION AFTER TOTAL KNEE REPLACEMENTMeredith B. Christiansen, Louise M. Thoma, Hiral Master, Robert Cowley, Emily Polakowski, Laura A. A. Schmitt, Daniel Rhon, Daniel WhitePhysical Therapy and Biomechanical and Movement Science, University of Delaware, Newark, Delaware; Physical Therapy, US Army-Baylor University, Houston, TexasPURPOSE/HYPOTHESIS: While standard postoperative care includes a 3-day discharge after surgery for Total Knee Replacement (TKR), utilization of outpatient physical therapy (PT) remains highly variable [1]. It is unclear why this occurs. preoperative and postoperative levels of physical activity (PA) may be an important predictor of utilization, though little is known about this association. The purpose of this study, therefore, was to explore the association of presurgical and postsurgical PA levels with subsequent utilization of PT services in people after TKR.NUMBER OF SUBJECTS: Forty-five participants receiving standardized PT care for a unilateral TKR at a University PT clinic between September 2015 and May 2016.MATERIALS/METHODS: We utilized data from an ongoing pilot study of PA after TKR. Presurgical (pre-TKR) PA was measured using self-report at the initial PT evaluation in response to the question, “What was your pre-injury physical activity level?” Response choices including predominantly sedentary or sitting with some standing were classified as Light pre-TKR PA, while walking, some handling of material or heavy manual work were classified as Moderate pre-TKR PA. Postsurgical (post-TKR) PA was ob-jectively measured as steps per day using an accelerometer (Actigraph GT3X) worn by the participant for the first week of PT. We categorized less than 2500 steps/d as Light post-TKA PA, and greater than 2500 steps/d as Moderate post-TKR. Utilization of PT was defined as the to-tal number of PT visits (frequency) and the number of days of service from admission to discharge (duration). Participants were classified as high or low utilizers based on the mean values of frequency and duration of PT. We explored the association of pre- and post-TKR PA (Light versus

Moderate PA) with high versus low utilizers, with unadjusted odds ratio (OR) and 95% confidence intervals (CIs).RESULTS: We used data from 32 participants (mean ± SD age, 65 ± 9 years; 56% female; BMI, 33 ± 7.5 kg/m2) who had 21 ± 6 PT appointments and 68 ± 23 days of PT. Participants with Light Pre-TKR PA were 1.5 times more likely to be high frequency of PT (95% CI: 0.34, 6.53) and 2.0 times as likely to have long duration of PT (95% CI: 0.45, 8.77) compared with those who with Moderate pre-TKR PA. Those with Light-post-TKR PA were half as likely to have a high frequency of PT OR = 0.5 (95% CI: 0.11, 2.32) and 25% less likely to have a long duration of PT (OR = 0.75; 95% CI: 0.17, 3.27) compared with those with Moderate post-TKR PA.CONCLUSIONS: PA before and after surgery may be an important marker of the frequency and duration of the utilization of PT after TKR. We found people who reported less active pre-TKR PA tend to be high utilizers of PT services. Conversely, participants who were less active post-TKR tend to be low utilizers of PT services. Our study conclusions are preliminary given our small sample size.CLINICAL RELEVANCE: Measuring PA after TKR may help to plan for the uti-lization of PT after TKR.

OPO41MORPHOLOGY AND CONTRACTILE PROPERTIES OF THE RECTUS FEMORIS MUSCLE DURING VARIOUS TASKS PERFORMED BY HEALTHY ADULT SUBJECTSZachary Christopherson, Ashley Lake, Heather Myers, Corina Martinez, Robert J. Butler, Chad E. CookPhysical and Occupational Therapy, Duke University, Durham, North Carolina; Duke University, Durham, North CarolinaPURPOSE/HYPOTHESIS: Traditionally, strength assessment of the quadriceps has focused on manual muscle testing and isokinetic testing protocols. Additionally, the cross-sectional area (CSA) of a muscle can be used to measure the amount of muscle available to produce strength [1-4]. The potential for assessment of this cross-sectional area is expanding through the use of portable ultrasound imaging devices. The aim of this study is to capture images of the rectus femoris muscle in healthy adults in order to establish a valid and reliable protocol for using musculoskeletal ultra-sound to assess muscle size and contractility of the rectus femoris muscle in patient populations.NUMBER OF SUBJECTS: Ten (5 male, 5 female) completed, with a final goal of 40 total subjects.MATERIALS/METHODS: All subjects completed the MARX Activity Questionnaire [5] and a body composition test using bioelectrical imped-ance. This was followed by ultrasound image capture of the rectus femo-ris (CSA) at 35% of the femur length in 3 conditions: quadriceps contrac-tion at 0° of flexion (quad set) with the knee resting over a 6-inch foam roll, and during a straight leg raise. Each condition was measured bilater-ally at rest and during contraction. Contractile index (CI) (CSA at rest – CSA during contraction) was calculated and compared utilizing Kruskal-Wallis analysis.RESULTS: A significant difference (0.009) existed for the (CI) of the rectus femoris on the right leg between quad sets (mean ± SD, 0.21 ± 0.41 cm2), foam roll (0.467 ± 0.33 cm2), and SLR (1.11 ± 0.78 cm2) positions. There was also a significant difference for the CI of the rectus femoris on the left leg between quad sets (0.17 ± 0.31 cm2), foam roll, (0.38 ± 0.31 cm2) and SLR (1.55 ± 0.78 cm2) positions.CONCLUSIONS: There appears to be a difference in CI of the rectus femoris between commonly prescribed exercises used for early strengthening dur-ing knee rehabilitation when measured in healthy subjects.CLINICAL RELEVANCE: With the improved feasibility of ultrasound imaging in the clinical setting, quadriceps contractile behavior may be more accu-rately and objectively measured. Knowing the contractile behavior of the knee extensors during various tasks and exercises in healthy subjects will allow future researchers, who will use imaging as an outcome for patients recovering from injury such as ACL reconstruction, a means to best study muscle morphology and force production.


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OPO42IN PECTORALIS MAJOR RUPTURES, DOES SURGICAL OR NONSURGICAL INTERVENTION PRODUCE BETTER STRENGTH OUTCOMES? A SYSTEMATIC REVIEWNathan Church, Coby Nattier, Morgan Stemple, Tom SneedSouthwest Baptist University, Bolivar, MissouriPURPOSE/HYPOTHESIS: In today’s American culture, physical fitness and appearance is greatly valued. Weightlifting has been popularized as has other high level sporting and fitness activities. With this greater popu-lation of athletes, more uncommon injuries are being noted as well to include pectoralis major muscle rupture. Unlike typical musculoskeletal injuries, a well defined standard of care has not been established for pec-toralis major rupture. Nonsurgical treatment has limited studies on in-complete ruptures focused on the geriatric population. Surgical treatment has been researched with a focus on which technique gives best outcomes. Cosmesis, pain reduction, and overall satisfaction are good outcomes but strength leading to return of function is most valuable. With this basic in-formation regarding pectoralis major rupture, physical therapists must be able to answer the question which leads to better strength outcomes, sur-gical or nonsurgical intervention?NUMBER OF SUBJECTS: Ninety-two.MATERIALS/METHODS: In February 2016 databases CINAHL, Cochrane, MEDLINE, and SPORTDiscus were searched using the terms, “pecto-ralis major rupture OR pectoralis major tear AND treatment.” Limiting time to 2000 to 2016 resulted in 241 articles. Removal of duplicates re-duced articles to 137. Title and abstract screening reduced the number to 8 studies. These were reviewed full text leading to exclusion of 4 stud-ies. The final 4 studies were assessed for their level of research design and strength of quality using a question tool from the AACPDM. Additionally, studies were assessed for strength outcome measures.RESULTS: All 4 studies were identified as level IV research. Three studies were cases series and 1 was a cohort series. All 4 studies received a qual-ity of study score of 5/7. This score results in studies showing moderate strength of evidence. From the 4 studies, 48 pectoralis majors had surgi-cal intervention and 44 had nonsurgical intervention. One study report-ed 6 nonsurgical went on to have surgery. Strength outcome revealed sur-gical intervention lead to peak torque of 74% to 110% of uninvolved side while nonsurgical intervention lead to only 56% to 75% of uninvolved side.CONCLUSIONS: Overwhelmingly surgery was far better for rupture. Strength outcome alone shows an 18% to 35% greater improvement in surgical in-tervention. Additional subjective outcome measures studied also dem-onstrated greater outcomes which include cosmesis, pain, and overall satisfaction.CLINICAL RELEVANCE: With surgical intervention obviously superior for strength outcome in complete ruptures, perhaps what is now more glar-ing is the gap in knowledge and evidence of how varying degrees of par-tial tear will best respond to surgical versus nonsurgical intervention. Additionally, how might the physical therapist accurately identify patients who require surgery versus those who would best respond to a nonsurgi-cal approach to rehabilitation? Clearly, these are the questions future re-search needs to answer.

OPO43EMG ACTIVITY OF THE MEDIAL AND LATERAL GASTROCNEMIUS MUSCLE IN TOE-IN AND TOE-OUT FOOT POSITIONS WHILE PRONE AND STANDINGMichael T. Cibulka, April WenthePhysical Therapy, Maryville University, St Louis, MissouriPURPOSE/HYPOTHESIS: The purpose is to examine if EMG activity is differ-ent between the MG and LG muscles in toe-in versus toe-out test position. Our hypothesis is the gastrocnemius when toe-in would elicit more LG ac-tivity than MG while toe-out would elicit greater activity in MG than LG. The gastrocnemius muscle comprises the MG and LG; the medial is more often injured than the lateral. No tests exist that distinguishes them.

NUMBER OF SUBJECTS: Thirty-three subjects.MATERIALS/METHODS: Thirty-three subjects were recruited. Electrodes were placed on the MG and LG. The gastrocnemius was tested prone, resist-ing knee flexion and during a standing heel-rise in toe-in and toe-out po-sitions. Tests were normalized against a MVIC during a heel raise in neu-tral. A 2-by-2-by-2 (test position by foot position by muscle) ANOVA was used to determine if differences exist in activity between the MG and LG for toe-in versus toe-out while standing and prone.RESULTS: Significant test position main effect (F1,32 = 86.9, P<.01), signifi-cant muscle main effect (F1,32 = 5.5, P<.01), and significant foot position by muscle interaction (F1,32 = 14.58, P<.01) were found. Follow-up test showed differences between MG and LG in toe-out position (t = 3.10, P<.01) but not in the toe-in for both test positions (t = 1.27, P = .21).CONCLUSIONS: With toe-out the MG was more active than LG in standing and prone; no difference was noted between MG and LG in toe-in for ei-ther position.CLINICAL RELEVANCE: This information may allow us to bias the MG over the LG when MMT or when strengthening the gastrocnemius muscle.

OPO44DIFFERENTIAL DIAGNOSIS OF RIGHT FLANK PAIN IN A PATIENT WITH GILBERT’S SYNDROME AND PERSISTENT COUGH: A CASE STUDY REPORTMark A. Ciolek, Craig P. HensleyPhysical Therapy, McCullough-Hyde Memorial Hospital, Cincinnati, Ohio; Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IllinoisBACKGROUND AND PURPOSE: Evaluating the source of a patient’s pain in the right flank region can be difficult, especially when complicated by me-chanical complaints and comorbidities. A clinician must consider ribs, accessory breathing musculature, abdominals, and visceral referral pat-terns. Gilbert’s Syndrome is a condition that alters bilirubin metabolism and effects an estimated 3% to 7% of the population. The purpose of this poster is to describe the clinical decision-making process for a patient with right flank pain after upper respiratory infection.CASE DESCRIPTION: The patient is a 44-year-old man with Gilbert’s syn-drome that presented with a 3 week presence of right flank pain that be-gan following an upper respiratory infection and severe coughing. The referring physician diagnosed the patient with a diaphragm strain. The patient reports minimal medical management of Gilbert’s syndrome and describes current symptoms as different than previous liver related pain. Chief complaints included coughing, lying supine, prone or on ipsilat-eral side, bed mobility, and sexual activity. Initial examination revealed signs and symptoms consistent with muscular strain with no abdomi-nal tenderness or pain related to recent eating or drinking habits. Testing showed pain with end range lumbar spine flexion, tenderness to palpa-tion of anterolateral ribs 8 to 10, and pain with supine curl-up. Flank pain improved quickly, but continued to persist for 1.5 weeks. The pa-tient returned after 15 days with minimal coughing, but significantly in-creased right flank pain. The patient reports the preceding days included increased driving, alcohol consumption, and poor diet habits including increased fat intake. At this time assessment shows pain with right up-per-quarter pain with deep palpation and led to a decision to refer back to referring provider. To note, original signs of pain with curl up and rib tenderness persisted.OUTCOMES: The patient was referred back to his primary care physician who completed a metabolic panel and ultrasound. Results demonstrat-ed no hepatic abnormality, but show a 3-mm gallstone and high biliru-bin levels.DISCUSSION: This case demonstrates the importance of ongoing reevalua-tion for individuals with Gilbert’s syndrome and right flank pain, even if initial physical therapy testing suggests musculoskeletal origin.REFERENCES: 1. Goodman CC, Boissonnault WG, Fuller KS. Pathology: Implications for the Physical Therapist. Philadelphia, PA: Saunders; 2009. 2. Strassburg C. Hyperbilirubinemia syndromes (Gilbert-


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Meulengracht, Crigler-Najjar, Dubin-Johnson, and Rotor syndrome). Best Pract Res Clin Gastroenterol. 2010;24:555-571. 3. Fretzayas A, Moustaki M, Liapi O, Karpathios T. Gilbert syndrome. Eur J Pediatr. 2012;171:11. 4. Naha K, Dasari S, Vivek G, Hande M, Acharya V. Severe unconjugated hyperbilirubinaemia: 1 and 1 makes 3? BMJ Case Reports. 2013;2013:bcr2013009962. 5. Hillenbrand A, Henne-Bruns D, Wurl P. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation. World J Emerg Surg. 2006;1:34. 6. Memon N, Weinberger BI, Hegyi T, Aleksunes LM. Inherited disorders of bilirubin clearance. Pediatr Res. 2016;79:378-386.

OPO45THE LAST ENCOUNTER: DIAGNOSTIC EXAMINATION AND MANAGEMENT OF A PATIENT WITH ABDOMINAL PAINLauren Clark, Jason Beneciuk, Robert RowePhysical Therapy, Brooks Rehabilitation, Orlando, FloridaBACKGROUND AND PURPOSE: Patients who present to physicians with ab-dominal quadrant pain are often referred to other medical providers to rule-out visceral pathologies; however injuries to the abdominal muscula-ture commonly present as symptoms in the abdominal region and may be appropriate for physical therapy management. These injuries commonly occur in athletes who perform unbalanced eccentric trunk rotations such as golfers; therefore it is important for clinicians to consider perpetuating factors that may have predisposed the athlete to injury and intervention strategies that will be most useful for resolution of symptoms and return to function. The purpose of this case report is to describe the use of exer-cise combined with thoracolumbar region targeted manual therapy to ad-dress abdominal pain in a recreational golfer.CASE DESCRIPTION: A 63-year-old man presented to physical therapy with an 18-month history of right lower quadrant pain that radiated to the upper quadrant with difficulty performing lumbar rotational and flexion movements such as golfing and household tasks. The patient had pre-viously been evaluated by multiple medical providers and underwent surgical cholecystectomy and kidney stone procedures with no relief of symptoms. He demonstrated muscular guarding and poor coordination of muscles of active spinal stabilization. Clinical outcome measures con-sisted of the Modified Oswestry Low Back Pain Questionnaire (ODI), nu-meric pain rating scale (NPRS), and the Patient-Specific Functional Scale (PSFS) administered at intake and 6 weeks. Interventions included co-ordination training for the thoracacolumbar region and joint mobiliza-tions to restore necessary dynamic movement patterns necessary for golf-ing and household tasks.OUTCOMES: Following 7 weeks of physical therapy the patient demonstrat-ed the ability to perform pain free movement patterns necessary for golf-ing and household activities and was able to participate in a graded return to golf at his desired frequency of 5 days a week. Improvements in NPRS (4 to 0), ODI (18% to 6%), and PSFS (5.5 to 7) scores were also observed, meeting minimal clinically important differences for pain and low back pain related function.DISCUSSION: With increased direct access opportunities, it is vitally im-portant for physical therapists to become efficient in medical screening and clinical decision making to distinguish between orthopaedic and vis-ceral conditions. Upon examination, reproduction of symptoms occurred with thoracic and lumbar movements in the transverse and sagittal planes which increased confidence that symptoms were of musculoskeletal ori-gin. Abdominal wall injuries may occur in patients who participate in re-petitive movements of the lumbar spine and are appropriate for physical therapy treatment when considering muscular coordination, movement, and loading. Screening for movement disorders that present as abdom-inal pain is an important component to physical therapy management which has the potential to limit unnecessary health care utilization and improve patient outcomes.REFERENCES: Dauty M, Menu P, Dubois C. Uncommon external abdomi-nal oblique muscle strain in a professional soccer player: a case report.

BMC Res Notes. 2014;7:684. George SZ, Beneciuk JM, Bialosky JE, et al. Development of a review-of-systems screening tool for orthopaedic physical therapists: results from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) cohort. J Orthop Sports Phys Ther. 2015;45:512-526. King E, Ward J, Small L, et al. Athletic groin pain: a sys-tematic review and meta-analysis of surgical versus physical therapy re-habilitation outcomes. Br J Sports Med. 2015;49:1447-1451. Rodeghero J, Denninger T, Ross M. Abdominal pain in physical therapy practice: 3 pa-tient cases. J Orthop Sports Phys Ther. 2013;43:44-53. Van Wyngaarden J, Ross M, Hando B. Abdominal aortic aneurysm in a patient with low back pain. J Orthop Sports Phys Ther. 2014;44:500-507.

OPO46NONINJECTABLE NEEDLING INTERVENTIONS FOR SHOULDER PAIN CONSISTENT WITH IMPINGEMENT SYNDROME: A SYSTEMATIC REVIEWDerek Clewley, Elizabeth Lane, Jeff Moore, Timothy W. FlynnPhysical Therapy, Duke University, Durham, North Carolina; Physical Therapy, University of Utah, Salt Lake City, Utah; Institute of Clinical Excellence, Windsor, Colorado; Physical Therapy, South College, Knoxville, TennesseePURPOSE/HYPOTHESIS: Subacromial impingement syndrome (SIS) is one of the more common disorders of the musculoskeletal system. Shoulder pain accounts for one third of physician office visits for musculoskeletal pain and the most frequent cause of shoulder pain is SIS. Though SIS is commonly associated with biomechanical and anatomical impairments, there have been a few studies published recently that demonstrate an as-sociation with soft tissue dysfunction and SIS. An APTA paper indicated a limited number of studies that included dry needling as a primary in-tervention for soft tissue dysfunction. The purpose of this systematic re-view was to synthesize and investigate the use of non injectable needling intervention strategies for the management of SIS.NUMBER OF SUBJECTS: Nine randomized controlled trials and 307 subjects total were included in this review.MATERIALS/METHODS: A systematic literature review consistent with the PRISMA guidelines was used to investigate the use of needling interven-tion strategies for SIS. All studies that investigated patients with shoulder pain consistent with SIS were included. Included techniques were those related to needling strategies where a non injectable needle approach was used targeting the shoulder complex with a specific focus on treatment of muscle tissue.RESULTS: Five trials that investigated the use of acupuncture and 4 trials that investigated the use of dry needling were included in this review. The PEDro risk of bias assessment tool was used. The average PEDro score for the acupuncture trials was 5.4. The average PEDro score for dry needling trials was 7.25. Included trials varied in the treatment intent and the type of outcome measures used and therefore only qualitative analysis could be performed. Pain pressure threshold (PPT) was included for all 4 studies focused on dry needling trials and all 4 trials had significant within group increased PPT. For the measure of pain, all trials demonstrated significant within group changes in pain. However, between group differences were only noted at immediate and 1 week.CONCLUSIONS: The findings from this systematic review provide insight re-garding the emerging effectiveness of dry needling. Both muscle tissue di-rected acupuncture and dry needling does appear to have immediate and short term effects on pain and PPT. However, none of the studies report-ed on long term effectiveness. There was inconsistency in the use of out-come measures to make a conclusion about effect on function. The type of needling strategy used was also inconsistent and the descriptions of tech-nique were often limited.CLINICAL RELEVANCE: The use of dry needling intervention strategies is be-coming widely used in physical therapy practice. The findings from this systematic review suggest that there might be an effect on pain and PPT both immediate and short term for SIS. There were no studies that looked at long term outcomes; therefore it is recommended if the clinician uses


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dry needling that it is incorporated into a treatment package that includes evidence supported interventions.

OPO47DOES THE PRESENCE OF RADIATING PAIN IN A COHORT OF CARE-SEEKING PATIENTS WITH BACK PAIN INFLUENCE OUTCOME?Spencer Cole, Thomas R. Denninger, Chad E. Cook, Timothy McHenry, Charles A. ThigpenResearch and Analytics, ATI Physical Therapy, Greenville, South Carolina; Department of Orthopedics, Duke University, Durham, North Carolina; Department of Orthopedics, Greenville Health System, Greenville, South CarolinaPURPOSE/HYPOTHESIS: Previous literature has established the presence of radiating pain in patients with low back pain as a prognostic indicator for worse outcome. This finding has been included in screening tools for low back pain such as the START Back Tool. The purpose of this analysis of a cohort of patients is to establish if difference exists in duration of care and outcomes in patients presenting to physical therapy with nonradiat-ing and radiating low back pain.NUMBER OF SUBJECTS: The study involves 368 patients with back pain with or without radiating lower extremity symptoms who received guideline oriented care by physical therapists over a 3-year period.MATERIALS/METHODS: The data included patients who were seen via direct access or through referral. Baseline measures of pain, disability (Oswestry disability index [ODI]), depression and quality of life were captured for each subject. Final outcomes measures captured include pain and the ODI. Comparative analyses between groups were performed for all base-line measures (using a t test/chi-square) and for discharge percentage change scores for pain and disability (using an analysis of covariance [ANCOVA]; α = .05).RESULTS: Of the 368 patients enrolled, 256 (69.5%) had low back pain without radiation and 112 (30.5%) had radiating symptoms. No differenc-es existed in baseline age, BMI, or baseline quality of life scores of patients in each group. Differences existed in number of PT session with those with radiating symptoms being seen 1.39 more visits (P = .011). Baseline pain and disability were not significantly different, nor was reductions in disability between groups.CONCLUSIONS: Despite the commonly accepted belief that the presence of radiating lower extremity symptoms in patients with low back pain is in-dicative of worse outcome, our findings did not support this. This dif-ference may be due to continued visits if the patient demonstrated pro-gression of symptoms where prior research has limited the number of PT visits. This suggests that a capitated number of visits for all patients is not an effective strategy to determine if conservative treatment is defini-tive for all patients.CLINICAL RELEVANCE: Clinicians should consider that some patients radiat-ing symptoms may have different lengths in episode of care but can be ex-pected to reach similar functional levels at discharge.

OPO48THE EFFECTS OF CORE STABILIZATION EXERCISE ON DISABILITY IN THE TREATMENT OF NONSPECIFIC LOW BACK PAIN AS COMPARED TO OTHER FORMS OF EXERCISE: A SYSTEMATIC REVIEWSherry T. Colson, Anna Fulton Barnes, Natalie Berg, Craig Howard, Courtney Purvis, Adam L. Robin, Haley SlighSchool of Physical Therapy, University of Mississippi Medical Center, Jackson, MississippiPURPOSE/HYPOTHESIS: Studies suggest that between 50% to 70% of Americans will be diagnosed with some type of low back pain (LBP) dur-ing adulthood. Risk factors for LBP include weakness and lack of motor control of the trunk and abdominal muscles. Core stabilization exercis-es (CSE) are a more recent approach to treating LBP. These exercises are based on research indicating that impairments in motor control of the deep abdominal muscles, including the transverse abdominis and lumbar

multifidus, may be an underlying cause of LBP. The purpose of this sys-tematic review is to measure the effects of CSE in the treatment of non-specific LBP as compared to other forms of exercise utilizing the Oswestry Disability Index.NUMBER OF SUBJECTS: Six studies.MATERIALS/METHODS: The PubMed database was searched in January 2016 with no date limitations using various terminology for LBP and stabi-lization treatment protocols. Specific search terms included “lumbago,” “core stability exercise,” and “Oswestry,” searched alone and in combina-tion. The electronic limit included the use of clinical trial studies. The in-clusion criteria specified the use of the ODI as an outcome measure and the use of studies that compare CSE that activate the TrA and LM with other forms of exercise. The exclusion criteria specified studies that com-pare CSE to manual therapy, modalities, or surgical intervention. Study quality was assessed using the PEDro Scale and CEBM Level of Evidence.RESULTS: Twenty-five articles were identified through the electronic screening process. After the title screen, abstract screen, and inclusion/exclusion screen, 6 articles met the criteria for inclusion in this systemat-ic review. The mean PEDro score was 5.5/10, ranging from 4/10 to 8/10. The frequency of CEBM levels included 2 level II studies, 2 level III stud-ies, 2 level IV studies.CONCLUSIONS: Three out of 6 studies with the highest level of evidence and best internal validity indicated a statistically significant improve-ment with CSE as compared to strengthening, conventional exercises, and stretching exercises. Two of the 6 articles resulted in no significant difference in the ODI compared to the Movement System Impairment-Based Treatment (MSI) and traditional trunk exercise, and 1 article indi-cated evidence that “Global Postural Reeducation” (GPR) may be signif-icantly better than CSE. All participants in the studies reviewed showed significant within-group improvements in ODI scores after participation in exercise.CLINICAL RELEVANCE: Based on the findings in this systematic review, CSE should be considered as a viable exercise option in the treatment of LBP. Overall, the evidence in these studies was graded as a “B” due to a mixture of moderate to strong CEBM levels and PEDro scores.

OPO49EFFECTS OF NOVEL DEVICE-SUPPORTED NEUTRAL SPINAL SITTING IN INDIVIDUALS WITH LOW BACK PAIN: A RANDOMIZED CONTROLLED TRIALPatricia Connors, Melodie Kondratek, Xianggui (Harvey) Qu, Sara F. MaherPhysical Therapy, Oakland University-School of Health Sciences, Rochester, Michigan; Physical Therapy Department, Wayne State University, Detroit, Michigan; Math Department, Oakland University, Rochester, MichiganPURPOSE/HYPOTHESIS: Sitting is a predominant work posture. Without muscle action or external support, sitting leads to a posterior pelvic tilt and a decreased lumbar lordosis, at times leading to low back pain (LBP). Sitting in a neutral spinal posture is preferred. There are currently no studies known that examined neutral sitting posture in adults with LBP for greater than 48 hours. This study investigated the effects of support-ing neutral sitting posture via a novel pelvic support device over 3 weeks in an adult population with LBP and a seated occupation. It was hypoth-esized that the subjects who utilized the device would have significant im-provements in pain, functional tolerance, ROM and strength.NUMBER OF SUBJECTS: Fifteen.MATERIALS/METHODS: Fifteen subjects between ages 20 and 65 with LBP who sat at a desk 25 or more hours/week were randomized into 2 groups: 8 subjects in the experimental group utilized the pelvic support device in their chair at their workplace during the trial and 7 subjects in the control group continued in their current desk set-up with no changes. Preoutcome and postoutcome measures included: Modified Oswestry Disability Index (ODI), numeric pain rating scale (NPRS), the fingertip to floor and Sorensen tests and hamstring extensibility. The device uti-


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lized is a portable unit that takes the shape of a 3-D triangle, is covered by a nonskid surface and has a cut out in the region of the coccyx for pressure relief. It is placed on the seat just posterior and caudal to the user’s ischi-al tuberosities. Through its shape and placement, it helps keep the pelvis from posteriorly rotating and aids in keeping the lumbar spine in a more neutral posture. Conflict of Interest (COI): The US patented devices used in this study are owned by Posture and Purpose, LLC. Patricia Connors, the Principal Investigator (PI) in this study, is majority owner of Posture and Purpose and invented the pelvic support device. For control of COI, the PI did not participate in any subject screening, consenting or clinical measures and all data were coded concealing group assignment until the completion of all data analysis.RESULTS: There were significant improvements in ODI and the averaged NPRS measures. MCID was also attained for ODI. There were no signifi-cant changes in any of the physical measures.CONCLUSIONS: The findings provide preliminary evidence that external support of neutral spinal position from the pelvis in sitting has a posi-tive effect on self-reported pain and functional tolerance levels in adults with LBP over a 3-week period. Changes in ROM and strength do not ap-pear associated with this postural change in the time frame investigated.CLINICAL RELEVANCE: Identifying effective options to support neutral spinal sitting posture, while minimizing passive strain on spinal structures and limiting the muscle activity needed to maintain this posture that can lead to fatigue, would be of benefit for the sitting health of individuals with and without LBP. This study demonstrates preliminary evidence that di-rect support at the pelvis may be an effective strategy.

OPO50CLINICAL EFFICACY AND SAFETY OF AN EARLY HOME EXERCISE PROGRAM AFTER ANTERIOR CERVICAL DISCECTOMY AND FUSION: A CASE SERIESRogelio A. Coronado, Clinton J. Devin, Erin E. Van Hoy, Christine M. Haug, Susan Vanston, Oran S. Aaronson, Kristin ArcherPhysical Therapy, University of Texas Medical Branch, Galveston, Texas; Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TennesseePURPOSE/HYPOTHESIS: Anterior cervical discectomy and fusion (ACDF) is the most common surgery for cervical spine conditions. Poor outcomes after ACDF have been linked to impaired muscle functioning from post-surgical disuse and deconditioning. Postoperative exercise can counter-act the effects of deconditioning and promote an increase in self-efficacy. To date, no study has determined whether performance of an early home exercise program (HEP) is safe and efficacious for improving ACDF out-comes. The purpose of this case series is to describe the clinical efficacy and safety of an early HEP performed within the first 6 weeks after ACDF.NUMBER OF SUBJECTS: Five consecutive patients (mean ± SD age, 53.0 ± 12.4 years; 4 female) who underwent ACDF were enrolled.MATERIALS/METHODS: Patients were given a 6-week HEP to be started im-mediately following hospital discharge after ACDF. The HEP interven-tion included daily walking, deep breathing, distraction techniques, cervical (limited to 30°) and upper body range of motion, cervical and shoulder isometrics, abdominal strengthening, and shoulder theraband exercises. Compliance (eg days completing exercise) and adverse events during the 6-week exercise phase were monitored using a diary log and weekly calls with a physical therapist. Patient-reported outcomes for neck and arm pain (Numeric Rating Scale), disability (Neck Disability Index), and physical and mental health (SF-12) were assessed preoperatively, after completing the HEP (6 weeks after surgery) and at 6-month fol-low-up. Self-efficacy (Pain Self-Efficacy Questionnaire) was measured at baseline, 6 weeks, and 6 months after surgery. Minimal clinically impor-tant differences were used to determine meaningful change in pain (2.6 points), disability (7.5 points), physical (8.1 points) and mental health (4.7 points), and self-efficacy (11 points). Safety was assessed with radiograph-ic imaging at 6 months.

RESULTS: After surgery and the early HEP, a majority of patients report-ed meaningful change in disability (4 patients at 6 weeks; 5 patients at 6 months), arm pain (4 patients at 6 weeks and 6 months), neck pain (4 pa-tients at 6 weeks; 3 patients at 6 months), and self-efficacy (3 patients at 6 weeks and 6 months). Two patients reported meaningful change in men-tal health at 6 weeks and 6 months. Only 1 patient reported meaningful change in physical health at 6 months. No adverse events were reported during the 6-week exercise phase. The average number of days perform-ing exercises was 33 days (79% of the 6-week period) with a range of 27 to 37 days (64%-83%). Radiographic imaging did not show any signs of abnormal healing after fusion.CONCLUSIONS: The findings of this case series suggest that an early HEP can be safely implemented immediately after surgery and may positively affect ACDF outcomes.CLINICAL RELEVANCE: These data support the early implementation of exer-cise after cervical spine fusion surgery with potential long-term benefits and no apparent safety concerns. Future trials will determine the effec-tiveness of an early HEP after ACDF.

OPO51EFFICACY OF MECHANICAL DIAGNOSIS AND THERAPY IN PATIENTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN: A RANDOMIZED PLACEBO-CONTROLLED TRIALLeonardo O. Costa, Alessandra N. Garcia, Luciola M. Costa, Mark J. Hancock, Fabricio Souza, Georgia Freschi, Matheus AlmeidaMasters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Physiotherapy, Macquarie University, Sydney, AustraliaPURPOSE/HYPOTHESIS: The McKenzie Method, also defined as “Mechanical Diagnosis and Therapy (MDT)” is commonly used in treatment patients with chronic low back pain (CLBP). This intervention has never been compared to a placebo treatment. We conducted a randomized placebo-controlled trial with 148 seeking care patients with CLBP to evaluate the efficacy of MDT.NUMBER OF SUBJECTS: One hundred forty-eight.MATERIALS/METHODS: This study was conducted in the outpatient physical therapy clinic of the Universidade Cidade de São Paulo, Brazil. Patients were randomly allocated through a computer system to either MDT (n = 74) or placebo (n = 74). The allocation was concealed. Patients from both groups received 10 treatment sessions, twice a week, for 30 to 40 minutes of session duration. The patients of MDT group were treated according to the principles of the MDT method. Patients allocated to the placebo group were treated with detuned pulsed ultrasound and shortwave dia-thermy. Patients from both groups also received an educational booklet. Clinical outcomes were obtained by a blinded assessor after treatment and at 3, 6 and 12 months after randomization. Primary outcomes were pain intensity and disability after the treatment. It was not possible to blind the therapists and patients to the conditions of treatment. The sta-tistical analysis was conducted in 74 patients from MDT group and 73 from placebo group.RESULTS: The MDT group had greater improvements in pain intensity at 5 weeks; mean effect, –1.0 point (95% CI: –2.09, –0.01) but not for dis-ability (–0.84 point; 95% CI: –2.62, 0.93). Patients did not report any ad-verse events. We have not detected any between-group statistical signifi-cance for all secondary outcomes.CONCLUSIONS: We concluded that MDT method was slightly more effec-tive than placebo for pain intensity, but not for disability immediately af-ter treatment in patients with CLBP.CLINICAL RELEVANCE: We considered that the magnitude of the differ-ence of pain found in this study is small and possibly of doubtful clini-cal importance.


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OPO52THE EFFECTS OF MANUAL THERAPY ON FUNCTIONAL OUTCOMES AND PAIN IN PATIENTS WITH HIP OSTEOARTHRITIS: A SYSTEMATIC REVIEWTerry Cox, Levi J. Hibma, Warren Frevert, Jill KalinowskiPhysical Therapy, Southwest Baptist University, Springfield, MissouriPURPOSE/HYPOTHESIS: Hip osteoarthritis (OA) is a degenerative condition that has been shown to produce pain and affect physical functioning in patients, becoming more debilitating as the condition progresses. With these difficulties, patients struggle with quality of life and productivity, as well as the cost burden of conservative and surgical treatments. While there is no cure for hip OA, manual physical therapy may be a viable treat-ment to reduce symptoms and increase patients’ quality of life. The pur-pose of this systematic review is to determine whether manual therapy has a positive effect on functional outcomes or pain when treating pa-tients with hip osteoarthritis.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: The following databases were systematically searched: CINAHL Complete, SPORTDiscus with full text, MEDLINE, MEDLINE with full text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Methodology Register. The keywords used were “hip osteoarthritis,” “manual thera-py,” “hip mobilization,” “hip mobilization,” “hip joint mobilizations,” “hip joint mobilization,” “hip joint mobilizations,” and “hip joint mobilization.” Studies that were identified as appropriate for this review were assessed for quality using the PEDro scale.RESULTS: The initial search yielded 126 articles which were then filtered by the authors and after excluding duplicates, 78 articles were left for ti-tle search. After a title and abstract search and reference search through a systematic review, 5 articles were chosen for this review. All 5 of the ar-ticles were deemed high quality using the PEDro scale. Therefore 5 stud-ies looking at manual therapy for patients with hip osteoarthritis were in-cluded in this review. Two of the reviewed studies utilized the WOMAC to measure improvement in function and showed benefits when using manual therapy. A third reviewed study that utilized the WOMAC did show improvements in function, but the results were not statistically sig-nificant. The final 2 studies reviewed utilized pain as a functional out-come measure, and both showed benefits in patient’s functional pain lev-els when utilizing manual therapy.CONCLUSIONS: Manual therapy, especially when combined with other treat-ments should be considered as interventions for improving functional outcomes and pain in patients with hip OA.CLINICAL RELEVANCE: Physical therapists should incorporate manual thera-py within their comprehensive treatment program to improve functional outcomes and reduce pain in patients with hip OA. While manual ther-apy has been shown to improve outcomes, it should not be used in isola-tion, but rather as a supplement to other treatments such as exercise and patient education.

OPO53EFFECT OF CONTINUUM OF CARE ON PATIENT OUTCOMES AND COMPLIANCE IN PEDIATRIC PATIENTS WITH ANTERIOR HIP PAIN: A RETROSPECTIVE REVIEWBriana Crowe, Mindy Galleher, Mitchell SelhorstSports Physical Therapy, Nationwide Children’s Hospital, Columbus, OhioPURPOSE/HYPOTHESIS: A positive relationship between therapist and pa-tient has been shown to influence patient compliance, satisfaction, and outcomes with therapy [1-4]. As part of this relationship, many physi-cal therapists feel that a good continuum of care is important to effective-ly treat their patients; however, it can be difficult to maintain this con-tinuity in a busy clinic. While patient satisfaction has been linked to a good continuum of care [5-6], it is currently unknown if a poor continu-

um of care affects patient outcomes. We hypothesized that the more ther-apists involved in care would result in worse patient outcomes and re-duced compliance. The primary objective of this study was to assess the effect of the number of treating therapists involved in an episode of care on patient outcomes. The secondary objective was to assess its effect on patient compliance.NUMBER OF SUBJECTS: From a retrospective database of patients with ante-rior hip pain, 164 patients (mean ± SD age, 14.3 ± 2.2 years) met the in-clusion criteria.MATERIALS/METHODS: This was a retrospective study consisting of the re-view of each patient’s medical chart. The information was obtained from a database of patients with anterior hip pain, treated between 2010 and 2015 at a pediatric sports and orthopaedic physical therapy department. The number of therapists who treated each patient was the independent variable. Reduction in pain per visit, change in patient self-reported out-come measures, and patient compliance with therapy were the dependent variables. Compliance was defined as attending approximately 75% of vis-its outlined in the therapist’s most recent plan of care. The covariates were duration of symptoms and initial pain levels. Data analysis: an analysis of covariance assessed the primary outcome and a chi-squared analysis cal-culated the secondary outcome.RESULTS: The mean ± SD reduction of pain per visit was 0.64 ± 0.39. Two or fewer therapists involved in care resulted in significantly greater reduc-tions in pain (mean difference, 0.30; 95% CI: 0.01, 0.59; P = .038 for 2 therapists and 0.3053; 95% CI: –0.0009, 0.6116; P = .051 for 1 therapist). The number of patients compliant with care was 111 (67.7%). No signifi-cant differences were noted between the number of therapists involved in care and compliance (P = .094). Patient self-reported outcome measures were evaluated, but no results could be derived due to approximately 75% of patients lacking outcome measures data.CONCLUSIONS: Having 2 or less therapists involved in a patient’s care was associated with significantly greater reductions of pain. The number of therapists involved had no significant effect on compliance.CLINICAL RELEVANCE: Maintaining a continuum of care of 2 or less thera-pists shows superior reduction in pain levels then having 3 or more ther-apists involved. This study gives support to the potential benefit of main-taining a good continuum of care to achieve optimal improvement in our patient’s pain levels.

OPO54DIAGNOSTIC IMAGING IN A DIRECT-ACCESS SPORTS PHYSICAL THERAPY CLINIC: A 2-YEAR RETROSPECTIVE PRACTICE ANALYSISMichael Crowell, Erik Dedekam, Michael Johnson, Scott Dembowski, Richard Westrick, Donald GossUS Military-Baylor University Sports Physical Therapy DSc Program, West Point, New York; Keller Army Community Hospital, West Point, New York; Columbia University, New York, New York; Moncreif Army Community Hospital, Fort Jackson, South Carolina; US Army Research Institute of Environmental Medicine, Natick, MassachusettsPURPOSE/HYPOTHESIS: The primary objective of this study is to describe the appropriateness of magnetic resonance imaging (MRI) or magnetic res-onance arthrogram (MRA) exams ordered by physical therapists in a di-rect-access sports physical therapy clinic. Secondary objectives are to de-scribe the utilization rates of diagnostic imaging, describe the diagnostic accuracy of the physical therapist’s clinical examination compared to MRI findings and, if applicable, surgical findings, and to compare utilization, appropriateness, and diagnostic accuracy between board certified phys-ical therapists and nonboard certified physical therapists. We hypothe-sized that: (1) greater than 80% of advanced diagnostic imaging orders will comply with American College of Radiology (ACR) Appropriateness Criteria (ACR rating greater than 6); (2) all physical therapists will uti-lize imaging at rates equal to or lower than previously published data; (3) agreement between the clinical examination diagnosis and the MRI/sur-


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gical diagnosis will be greater than 75%; (4) board-certified physical ther-apists will utilize diagnostic imaging at lower rates and with increased ap-propriateness based on ACR criteria.NUMBER OF SUBJECTS: One hundred eight patients with MRI/MRA exami-nations ordered by a physical therapist.MATERIALS/METHODS: The study design was a 2-year retrospective practice analysis. A board-certified radiologist determined the appropriateness of each order based on ACR. The principal investigator and coinvestigator radiologist assessed agreement between the clinical diagnosis and MRI/surgical findings.RESULTS: Knee (31%) and shoulder (25%) injuries were the most com-mon. Overall, 55% of injuries were acute. The mean ACR rating was 7.7 and the percentage of orders complying with ACR appropriateness cri-teria was 83.2%. Physical therapist’s clinical diagnosis agreed with the MRI/MRA findings in 64.8% of cases and agreed with surgical findings in 90% of cases.CONCLUSIONS: Physical therapists providing musculoskeletal primary care in a direct-access sports physical therapy clinic appropriately ordered ad-vanced diagnostic imaging in over 80% of cases. Future research should prospectively compare physical therapist appropriateness and utilization to other groups of providers and explore the effects of physical therapist imaging privileging on outcomes.CLINICAL RELEVANCE: Physical therapists appear to appropriately order ad-vanced diagnostic imaging at rates that do not exceed other published data.

OPO55CONFIDENCE OF PHYSICAL THERAPISTS’ DIAGNOSTIC CLINICAL DECISION MAKING USING SPECIAL TESTS DURING A SHOULDER EVALUATION: A QUALITATIVE STUDYRyan Cummings, Deborah Davey, Bradley Myers, Aaron KeilPhysical Therapy, University of Illinois at Chicago, Chicago, IllinoisPURPOSE/HYPOTHESIS: Recent literature indicates poor diagnostic accura-cy for shoulder special tests during an evaluation. There is minimal evi-dence to determine if a change in diagnostic accuracy is influenced by the use of special tests. This study attempts to add to the current literature. Opinions vary on the importance of clinical special tests within a shoul-der evaluation. The purpose of this study was to determine whether con-fidence in diagnostic hypotheses using shoulder special tests is dependent on the years of experience and expertise.NUMBER OF SUBJECTS: Ninety-five.MATERIALS/METHODS: One hundred fifteen physical therapists responded to an online survey distributed through the Orthopaedic Section of the American Physical Therapy Association (APTA), in addition it was post-ed to several social medial platforms followed by orthopaedic physical therapists. Survey respondents consisted of Doctors of Physical Therapy (DPT) students on orthopaedic internships, physical therapists of less than 1 year, 1 to 5 years, 5 to 10 years, and over 10 years of experience. Survey was completed by 95 out of the 115 respondents, consisting of 46 females and 49 males, with a mean ± SD age of 32 ± 9.2 years. A 13-ques-tion survey included demographic questions related to number of years of experience, and postgraduate clinical experiences or education. Questions regarding confidence of diagnostic hypothesis during a shoulder evalua-tion were reported on a Likert scale 0 (not confident at all) to 5 (very con-fident). Clinicians’ primary influence during an evaluation for diagnostic hypothesis was explored based upon years of experience and expertise. Data were analyzed using IBM SPSS Statistics to determine if relation-ships exist between reported years of experience, postprofessional educa-tion and rated confidence levels following special tests.RESULTS: No significant differences or correlations were found between years of experience and confidence levels following the performance of an orthopaedic shoulder evaluation. Significant differences (P<.05) were found between groups with and without specialty certifications while per-forming the subjective portion of the evaluation; however, there were no

significant changes in confidence based upon objective and special test outcomes. Physical therapists with postprofessional education showed no significant differences between confidence levels following special tests.CONCLUSIONS: Results indicate that the level of confidence during an or-thopaedic shoulder evaluation remain constant and was not dependent on years of experience or influenced by special tests. Less reliance on spe-cial tests was seen with increased years of experience.CLINICAL RELEVANCE: The lack of significant changes in confidence between years of experience and expertise, demonstrates less reliance on special tests based upon responses. This study provides a foundational study for further investigation on clinicians’ confidence with special tests in the consideration of physical therapy education.

OPO56FRONTAL PLANE PROJECTION ANGLE AND ACCELERATIONS DURING THE SINGLE-LEG SQUAT WITH VISUAL PERTURBATIONRobert B. Dale, Taylor L. Price, Luke Ford, Katie Megahee, Morgan Duncan, Nick TolstickPhysical Therapy, University of South Alabama, Mobile, AlabamaPURPOSE/HYPOTHESIS: Faulty movement patterns provide the therapist with information on the patient’s diagnosis and visual feedback to the patient during such tasks is improves performance. The single-leg squat (SLS) is one such functional test and the purpose of this study was to compare frontal plane projection angles (FPPA) and accelerometer data in the SLS with normal vision and with visual perturbation in healthy in-dividuals to establish normative data. We hypothesized to see differenc-es between the conditions and that visual perturbation would increase movement variability but not necessarily FPPA.NUMBER OF SUBJECTS: Thirty-eight healthy subjects (22 female, 16 male) that were 24.7 ± 3.3 years old and weighed 74.1 ± 1.6 kg.MATERIALS/METHODS: In a counter-balanced, repeated-measures design, subjects performed squats in 2 visual conditions: Normal vision and then while wearing visual perturbation strobe-glasses set at 30 Hz (OpuS USA, West Milford, NJ). The squatting technique was performed in 2 condi-tions, single leg and also double-legged, which served as a control con-dition. Both squatting conditions required the subject to squat to 60° of knee flexion using a predetermined seat target for consistency while moving at an externally-paced metronome recording set to 30°/s. The SLS required subjects to squat with the dominant leg. A smartphone was attached to the subjects’ distal thigh, and data were exported using the Sensor Kinetics Pro accelerometer application that recorded data at 30 Hz. Raw accelerometer data were filtered and a composite index was computed for all 3 axes, and z-axis (mediolateral) data were also extract-ed for comparison. For the z-axis data, a coefficient of variation (COV) was computed. The FPPA was calculated at the knee position of 60° with the 2-dimensional HUDL technique video analysis application recording at 30 Hz. Accelerometer data were subsequently compared with a condi-tion by vision repeated measures ANOVA and post hoc paired t tests cor-rected for alpha inflation with the Bonferroni procedure using SPSS soft-ware (Version 22.0; IBM, Armonk, NY).RESULTS: The FPPA grand mean was 174.5° ± 2°, and was not different be-tween conditions (P>.05). For the composite axes data, we found signifi-cant main effects for vision (P = .034), condition (P<.001), and also the in-teraction of vision and condition. For the interaction, paired t tests showed a significant difference (P = .04) between the SLS strobe (9.86° ± 0.07°) compared to the SLS with normal vision (9.85° ± 0.6°). The SLS strobed condition (0.82° ± 0.3°) also had a higher COV (P<.001) with the z-ax-is (mediolateral) data compared to SLS with normal vision (0.75° ± 0.3°).CONCLUSIONS: This data show that despite a small FPPA angle of approxi-mately 5°, accelerometer data revealed that subjects performed differently in the various conditions, but particularly in the SLS with visual perturbation.CLINICAL RELEVANCE: The oscillations detected by the smartphone acceler-ometer provide objective information about movement quality during the SLS that are not associated with a large FPPA.


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OPO57THE EFFECT OF GAIT CADENCE MODIFICATIONS ON KNEE JOINT LOAD DURING WALKINGChristine Davis, Charles Homoky, Daniel Karam, Chieh Lo, Kristofer Lopardo, Brennan Jackson, Alison H. ChangPhysical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois; Biomedical Engineering, Northwestern University, Evanston, IllinoisPURPOSE/HYPOTHESIS: Knee osteoarthritis (OA) commonly affects the me-dial tibiofemoral (TF) and/or the patellofemoral (PF) compartments, and often leads to disability and functional limitation. Elevated external knee adduction moment (KAM) and external knee flexion moment (KFM) during stance phase of gait increases medial TF and PF load respectively. Greater KAM and KFM have been linked to OA disease progression and subjective complaints of pain [1,2]. Many interventions aimed to lower knee load during gait and ultimately slow disease progression [3-6]. A previous study [7] showed that increasing runners’ cadence by 5% to 10% reduced KFM and PF joint force. It is unclear whether this observation translates into walking, a less demanding task. The purpose of this study was to examine how cadence modifications at a fixed self-selected walk-ing speed influence KAM and KFM during gait.NUMBER OF SUBJECTS: Twelve persons contributing 24 knees.MATERIALS/METHODS: Healthy participants ambulated on a split-belt tread-mill at a self-selected speed and cadence. Following this control condi-tion, participants underwent 2 randomized conditions: 10% increase in cadence (+10%) and 10% decrease in cadence (–10%) at the same self-selected speed. KFM and KAM were measured using the instrumented split-belt treadmill (R-Mill, Force Link, the Netherlands) and 10-camera motion capture system (Qualisys, Sweden). After baseline control tread-mill walking, participants were given 10 minutes to adapt to the altered cadence for the 2 randomized conditions. Gait kinematics and kinetics were processed and computed using the Visual3D software (C-Motion, USA). A repeated-measures analysis of variance (ANOVA) was used to compare the 3 conditions and Bonferroni post hoc tests for pairwise com-parisons, with the peak KAM and KFM as dependent variables and the varying cadences as independent variables.RESULTS: Mean ± SD peak KAM was 2.004% ± 0.729% body weight·height in the control condition, 2.096% ± 0.742% in +10% cadence, and 2.021% ± 0.649% in –10% cadence. Mean ± SD peak KFM was 4.252% ± 0.729% body weight·height in the control condition, 3.800% ± 1.211% and 4.808% ± 1.486% in +10% and –10% cadence, respectively. KAM did not differ among 3 conditions (F1.47,33.89 = 1.58, P = .22). KFM differed among 3 conditions (F2,46 = 46.73, P<.0005); +10% cadence resulted in 11% low-er KFM and –10% cadence had the opposite effect of 13% greater KFM.CONCLUSIONS: Walking with a faster cadence significantly reduced peak KFM. Similar to the observations in runners, these results suggest that increasing cadence is an effective strategy at reducing KFM, thereby re-ducing PF compressive forces during gait.CLINICAL RELEVANCE: The findings of this study support a simple and effec-tive approach to significantly reduce PF knee load, which may in turn re-lieve pain during walking. This creates a possible adjunct to therapy for patients with PF pain or knee OA, as it may decrease load and pain during daily ambulation. Further investigation is needed to examine the longer-term effect of this intervention on KAM, KFM, and subjective reports of pain in patients with PF pain and/or knee OA.

OPO58THE EFFECTS OF MYOFASCIAL RELEASE ON THE LATENCY OF DELAYED-ONSET MUSCLE SORENESSDuane S. Davis, Michael Piazza, Caleb Dodd, Kenneth C. Paz, Joey Potesta, Kayla Weiser, Corrie A. MancinelliHuman Performance and Exercise Sciences, West Virginia University, Morgantown, West Virginia

PURPOSE/HYPOTHESIS: The purpose of this study was to determine the ef-fectiveness of a manual myofascial release technique (MFRT) in reducing the symptoms of delayed-onset muscle soreness (DOMS) in recreation-al athletes. Previous research has shown that many proposed treatments for DOMS are not effective at reducing eccentric-induced muscle sore-ness. One of the most effective interventions has been shown to be manu-al massage. It is unclear if manual myofascial release is effective in reduc-ing pressure pain threshold and perceived pain associated with DOMS.NUMBER OF SUBJECTS: Thirty recreational athletes were recruited to partic-ipate in the investigation; however, 10 subjects did not develop sufficient DOMS (operationally defined as greater than 20% decrease in pressure pain threshold 48 hours postexercise) and were excluded from the study. Thus, 20 adult athletes (16 women, 4 men) participated in this investiga-tion. Mean ± SD for age was 24 ± 1.2 years.MATERIALS/METHODS: Before the initiation of the eccentric protocol to create DOMS, baseline perceived pain level and pressure pain threshold (PPT) were assessed using the visual analog scale (VAS) and pressure algometry, respectively. The PPT measurement sites were standardized according to anatomic landmarks on the right thigh. Participants completed the DOMS protocol, consisting of 5 sets of 25 eccentric quadriceps contractions on a Cybex dynamometer. Forty-eight hours after the protocol completion, pretreatment measurements were taken to establish the baseline level of DOMS. Participants were randomly assigned to the treatment or control group. The treatment group received the manual MFR technique on the lateral side of the right thigh between the greater trochanter and lateral epicondyle of the femur. Pressure pain threshold and VAS measurements were collected at 5 minutes, 20 minutes, and 24 hours posttreatment. Data were analyzed using a repeated measures ANOVA.RESULTS: There was not a significant interaction effect between group and time for PPT (P = .16) or VAS (P = .45). There was not a significant main effect for group for PPT (P = .59) but there was for VAS (P = .01). There was a significant main effect for time for both PPT (P< 0.03) and VAS (P = .002).CONCLUSIONS: Based on the results of this investigation, there is inconclu-sive evidence to support the use of myofascial release technique to reduce pressure pain threshold in subjects with eccentric-induced delayed onset muscle soreness. This study supports long-standing evidence that time is perhaps the most effective treatment for reducing the symptoms of de-layed onset muscle soreness. Further research with a larger sample size and a higher dose of the treatment technique is warranted.CLINICAL RELEVANCE: Healthcare providers, coaches, and athletes have long sought to identify effective interventions to reduce and speed the recov-ery of eccentric-induced delayed onset muscle soreness. There is insuffi-cient evidence at this time to support myofascial release techniques as an effective treatment.

OPO59EFFECTS OF SENSORIMOTOR TRAINING ON LIMITS OF STABILITY POSTUROGRAPHY MEASURES IN HEALTHY INDIVIDUALS: A PROOF-OF-CONCEPT INVESTIGATIONDuane S. Davis, Michael Priestas, Emily Hargreaves, Shane Piatt, Chelsea Anderson, Stephen ArmitageArmitage, Human Performance and Exercise Sciences, West Virginia University, Morgantown, West VirginiaPURPOSE/HYPOTHESIS: Nonacute low back pain (NALBP) is a common condition in western cultures. Recent literature supports that individuals with NALBP have altered sensorimotor and postural control. Identifying the effectiveness and optimal dose of a sensorimotor training program may offer a novel, nonopioid treatment alternative in this population. Before conducting a randomized controlled trial (RCT) in individu-als with NALBP, a proof of concept investigation with healthy subjects was designed to provide preliminary data and assess the feasibility of the training program. It is hypothesized that a properly dosed pragmatic sen-sorimotor training program will improve measures of posturography, re-


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duce pain, and improve function in individuals with NALBP.NUMBER OF SUBJECTS: Twenty-four healthy adults (7 male, 17 female) par-ticipated in this investigation. Mean ± SD for age was 21.0 ± 1.6 years.MATERIALS/METHODS: Participants were randomized to the treatment or control group (n = 12 experimental, n = 12 control). The treatment group participated in a 4-week (30 minutes, 2 times per week) pragmatic sen-sorimotor training program that included kinesthetic and graphesthesia training, traditional motor control/strengthening exercises, and novel di-aphragm/respiratory training with a SpiroTiger (SpiroTigerMedical) de-vice. The control group received a 5-minute educational session that fo-cused on the anatomy and biomechanics of the lumbar spine. Limits of stability measures (reaction time, movement velocity, directional control. and maximal excursion) were assessed using the Balance Master Version 7.0.9 at baseline and at 5 weeks.RESULTS: Independent pooled t tests revealed no statistical differences be-tween the treatment and the control groups for any of the tested vari-ables; however, several variables approached the alpha level of .05. The P value for reaction time in the forward direction was .06, and a post hoc power analysis revealing that n = 27 subjects would be needed to have a power of 0.80 with a raw effect size of 0.33 seconds.CONCLUSIONS: This proof of concept investigation did not reveal a statisti-cal difference between groups in healthy subjects over a 4-week training program. It is hypothesized that the effect sizes will be larger in individ-uals with NALBP that have altered sensorimotor function. The training protocol was designed for individuals with NALBP; thus, it is believed that the treatment dose was insufficient for healthy individuals. When translated to individuals with NALBP, the treatment duration will be ex-tended to 8 weeks.CLINICAL RELEVANCE: As movement system specialists, physical therapists need to better understand how individuals with LBP move and respond to targeted training programs to help prevent chronification and recurrence of LBP. While the results of this study cannot be translated into clinical practice, valuable information was obtained to help design an RCT for in-dividuals with NALBP.

OPO60SPINAL IMAGING IN PATIENTS WITH SYMPTOMATIC LOW BACK PAIN: A SYSTEMATIC LITERATURE REVIEWJessica Davis, Daniel Rhon, Ben R. Hando, Robert BoylesWilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Texas; Physical Therapy School, University of Puget Sound, Tacoma, Washington; Graduate Programs in Physical Therapy, Baylor University, San Antonio, Texas; Manual Therapy Fellowship, Evidence in Motion, Louisville, KentuckyPURPOSE/HYPOTHESIS: Rates of advanced imaging in the lumbar spine con-tinue to rise despite a growing body of literature indicating its limited value for individuals with low back pain (LBP). Some studies have even shown an increased risk of poor outcomes with overutilization of imag-ing. Systematic reviews have pooled data on abnormal findings in asymp-tomatic individuals with low back pain, however, no reviews to date have included only symptomatic low back pain patients. Therefore, the pur-pose of this review was to identify the ratio of patients with abnormal findings to those without in a population specifically with symptomatic low back pain.NUMBER OF SUBJECTS: Four thousand three hundred eighty-four total sub-jects with low back pain.MATERIALS/METHODS: An online search was conducted on PUBMed for studies published through May 2016. Search strategy included keywords such as “low back pain,” “spine pain,” and “imaging,” “radiographs” or “MRI,” and “asymptomatic,” “irrelevant,” and “incidental.” Studies were included if authors reported the specific number of unique patients with or without back pain, and excluded if they included only asymptomat-ic subjects. Only patients with low back pain were extracted from stud-ies that included both symptomatic and asymptomatic patients for the fi-

nal count.RESULTS: Out of 1389 potential studies, 11 were included in the final assess-ment, representing a total of 4384 subjects. Ages ranged from 14 to 86, with a median age of 46. Of these, 1824 (41.6%) unique patients with low back pain had an abnormal finding on imaging, while the majority 2560 (58.4%) had normal imaging reports. Large heterogeneity with reporting methods, such as reporting number of findings versus unique individuals, limits the studies from which counts of unique individuals can be extract-ed. In the studies analyzed, the majority of patients that sought medical care for low back pain had normal findings. Most studies with longitudi-nal data related to pain and disability, showed no significant association between changes in imaging abnormalities and changes in symptoms. The exception was in Modic endplate changes, which showed a greater association, at specific levels, with symptoms in some subsets of patients with low back pain.CONCLUSIONS: While spine abnormalities on imaging are common in as-ymptomatic individuals, this review found that they are also common in symptomatic patients with low back pain. However, there were higher rates of normal findings in symptomatic individuals compared to abnor-mal findings.CLINICAL RELEVANCE: It may be more likely that patients seeking medical care for low back pain have normal imaging findings than abnormal find-ings. Patients may still have high levels of pain and disability, and clini-cians may need to focus on other education strategies that help explain pain and the cause of symptoms to the majority of patients seeking care for low back pain.

OPO61THE RELATIONSHIP BETWEEN ELECTROMYOGRAPHIC ACTIVITY AND PERCENT CHANGE IN MUSCLE THICKNESS OF THE SERRATUS ANTERIORJoseph M. Day, Robert B. Dale, Sean A. HillerUniversity of South Alabama, Mobile, AlabamaPURPOSE/HYPOTHESIS: Research consistently demonstrates that individu-als with shoulder pathologies are likely to have altered serratus anterior (SA) muscle performance. Assessment of the SA using ultrasound imag-ing (UI) allows real-time visualization of the isolated changes in muscle thickness. A reliable method for measuring SA thickness has been report-ed, yet the procedure has never been formally validated. The purpose of this study was to determine the relationship between electromyography (EMG) and percent change in thickness of the SA as measured by UI.NUMBER OF SUBJECTS: Thirty subjects (mean ± SD age, 24 ± 2 years; 53% male; 94% right-handed).MATERIALS/METHODS: Healthy subjects were positioned in a standardized sitting posture and anatomical landmarks were marked for ultrasound probe and EMG surface electrode placement. Tegaderm occlusive dress-ing was applied over the electrode in order to prevent ultrasound gel from interfering with the EMG signal. EMG activity of the SA was recorded during rest, and subsequent isotonic EMG activity was normalized to the subject’s maximum voluntary isometric contraction (MVIC). Subjects were asked to raise the upper extremity from a resting position to 120° of scaption for a total of 3 trials. Upper extremity elevation velocity was ex-ternally paced by previously recorded verbal instructions at a rate of 10°/s. EMG activity was collected through the entire range of motion, while ul-trasound images were taken at rest and at 120° of scaption. EMG sig-nals were real-time conditioned with proprietary manufacturer software (Sierra Wave). SA thickness measures were obtained post hoc with man-ufacturer software (Mindray MSK Z6). Percent change in thickness was calculated by subtracting the average rest value from the average contrac-tile value, and dividing the difference by the average rest value. A paired t test was used to compare absolute resting from contractile values at 120° of scaption both for EMG and ultrasound data. Pearson’s correlation co-efficient was used to determine the relationship between the normalized EMG activity at 120° of elevation and the ultrasound data.RESULTS: There were significant increases in both EMG activity and ab-


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solute muscle thickness when comparing resting values to 120° of scap-tion (P<.001). There was a significant relationship between percent MVIC EMG activity and the percent change in muscle thickness (P = .01) (r = 0.49, R2 = 0.26).CONCLUSIONS: There is a moderate positive relationship between SA EMG activity and percent change in muscle thickness as measured by UI. However, more research is needed with a pathological population to vali-date the use of UI in measuring SA muscle performance.CLINICAL RELEVANCE: UI has the potential to be used on the SA as a means of assessment or biofeedback in a clinical setting.

OPO62PSYCHOSOCIAL FACTORS ASSOCIATED WITH DISABILITY IN PATIENTS WITH CHRONIC LOW BACK PAINJustine Dee, Sharon HenryRehabilitation and Movement Science, University of Vermont, Burlington, Vermont; Physical Therapy, University of Vermont Medical Center, Burlington, VermontPURPOSE/HYPOTHESIS: The combination of physical and psychosocial factors associated with improved outcomes in the care of chronic low back pain (LBP) is unclear [1-5]. We assessed which factors were most strongly associated with treatment success, regardless of physical thera-py treatment. We hypothesized that psychosocial variables would corre-late with and could predict the initial Oswestry Disability Index (ODI). Furthermore, we hypothesized that psychosocial variables could predict treatment success.NUMBER OF SUBJECTS: Ninety-two subjects with chronic low back pain (NCT01362049).MATERIALS/METHODS: In this prospective study, subjects were treated for 6 weeks with a matched or unmatched treatment according to classifica-tion based on the Treatment Based Classification or Movement System Impairment schema [1,6-8]. Primary outcome measures (ODI) were tak-en at pre and posttreatment, and at 6 and 12 months. Treatment suc-cess was defined as an 8% or greater reduction on the ODI from pre to posttreatment [9]. In this planned secondary analysis, predictive vari-ables included 5 psychosocial variables: the Fear-Avoidance Behavior Questionnaire, Short Form (SF)-36, Patient Health Questionnaire 9 (PHQ9), Stanford Presenteeism Scale, and the Baecke Leisure Questionnaire (BLQ). Pearson’s Correlation Coefficient was performed to assess correlations between ODI scores and all 5 psychosocial variables. A linear regression model determined the association between the initial psychosocial variables and the initial ODI. Logistic regression was used to determine if any psychosocial variables predicted treatment success.RESULTS: Pearson’s Correlation Coefficient demonstrated significant cor-relations (0.22-0.46) between the initial ODI and initial psychosocial measures except the BLQ. Also, there were moderate correlations (0.30-0.56) between the posttreatment ODI and the posttreatment psychoso-cial measures, (except the BLQ and the SF-36 mental health component). Furthermore, post treatment ODI was highly correlated with all initial psychosocial measures (0.31-0.55) except the BLQ. The linear regression model demonstrated significant association between initial ODI and ini-tial SF-36 (physical activity) score (P = .01) and the PHQ9 (P = .004). Logistic regression modeling found treatment success significantly asso-ciated with initial ODI (P = .01) but not with any of the other psychoso-cial measures.CONCLUSIONS: Our study demonstrated that initial psychosocial measures are correlated with initial and posttreatment disability due to LBP and that initial psychologic (PHQ9) and physical (SF-36 physical activity) measures are predictive of initial disability. Both initial and 6 week ODI score are predictive of treatment success.CLINICAL RELEVANCE: An interdisciplinary approach is warranted in the treatment of patients with LBP to reduce depression, address fear of movement, and promote activity and participation. Using tools to assess physical function and depression at the onset of treatment of LBP can

successfully screen patients to determine who may require additional ser-vices to promote reduction of LBP disability.

OPO63MANUAL THERAPY FOR NONCARDIAC-RELATED CHEST WALL PAIN: A CASE REPORTAbby Dill, Michael O’Hearn, Jeffrey D. ClarkLakeland Orthopedic Physical Therapy, Lakeland Health, Saint Joseph, Michigan; Imove, Spring Lake, MichiganBACKGROUND AND PURPOSE: Chest wall pain is one of the most common rea-sons individuals seek medical attention in the world. Because of the na-ture of the symptoms and the possible resemblance of signs and symp-toms of a heart attack, chest wall pain accounts for 7.16 million visits to the emergency room annually in the United States. Only about one third are diagnosed with acute coronary symptoms and the remaining with noncardiac chest pain. Patients with noncardiac chest pain continue to experience chest pain for 1 to 11 years after the initial episode and al-most half of noncardiac chest pain patients still believe they have a car-diac condition up to 1 year after negative cardiac evaluations. About 30% of noncardiac chest pain patients are diagnosed with costochondritis. No systematic reviews or clinical trials regarding optimal treatment for cos-tochondritis have been identified. The purpose of this case report is to de-scribe the successful treatment of a patient diagnosed with costochondri-tis and the important role physical therapy plays in easing anxiety over chest wall pain.CASE DESCRIPTION: A 29-year-old man presented with left sided anterior chest wall pain that began insidiously about 1 year prior. His pain was de-scribed as a strong ache, rated 6/10 on the numeric pain rating scale. He went to the emergency room on 2 separate occasions due his symptoms and the fear of a heart attack, with negative findings. Significant past med-ical history included anxiety. Examination revealed: pain with left shoul-der combined flexion, adduction and external rotation with overpressure, seated AROM thoracic left rotation with overpressure and with palpation of the left fourth to sixth costosternal joint, pain and hypomobility of the upper thoracic spine and a positive left upper limb neural provocation test with median nerve bias. Interventions included anterior to posterior mo-bilization at the left fourth to sixth costosternal joint, posterior to anterior mobilization to the upper thoracic spine (T2-T7), pectoral stretching for home and assurance that his chest wall pain was musculoskeletal.OUTCOMES: Three physical therapy appointments resulted in improve-ments in: pain 0/10 at the worst, pain-free AROM thoracic rotation, pain-free left shoulder combined flexion, adduction and external rotation, negative neural provocation testing, Neck Disability Index score: 0/100, and decreased anxiety.DISCUSSION: Costochondritis is a common cause of noncardiac chest pain. This case report details the successful treatment of a 29-year-old man with a diagnosis of costochondritis who reported to the emergency de-partment on 2 separate occasions due to the nature of his chest pain. Physical therapy assessment clearly reproduced the patient’s pain, which had not occurred in previous medical visits. Earlier multimodal therapy intervention could have saved unnecessary visits to the emergency depart-ment and improved his quality of life sooner.REFERENCES: 1. Eken C, Oktay C, Bacanli A, et al. Anxiety and depressive disorders in patients presenting with chest pain to the emergency de-partment: a comparison between cardiac and noncardiac origin. J Emerg Med. 2010;39:144-150. 2. Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care. 2013;40:863-887. 3. Jonsbu E, Dammen T, Morken G, Moum T, Martinsen EW. Short-term cognitive behavioral therapy for noncardiac chest pain and benign pal-pitations: A randomized controlled trial. J Psychosom Res. 2011;70:117-123. 4. Proulx A. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;80:617-620 5. Yelland M. Back, chest and abdominal pain: how good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain? Aust Fam Physician. 2001;30:908-912.


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OPO64DOES THE DIRECTION OF ELASTIC TAPE APPLICATION INFLUENCE JUMPING ABILITY IN ASYMPTOMATIC INDIVIDUALS?Michelle Dolphin, Adam Rufa, Gary BrooksPhysical Therapy Education, Upstate Medical University, Syracuse, New YorkPURPOSE/HYPOTHESIS: Elastic tape is commonly used for athletic perfor-mance enhancement. One of the proposed mechanisms for the effects of elastic tape is changes in local muscle contractions. This study examined the short term effects of the direction of elastic tape application to the quadriceps muscle on 2 jumping tasks.NUMBER OF SUBJECTS: Fifteen.MATERIALS/METHODS: Fifteen healthy subjects (9 female, 6 male), with a mean age of 23 years, participated in this pilot study. Using a crossover design, subjects were tested over 2 sessions with a one-week washout pe-riod between sessions. All subjects were naïve to the use of elastic tape. Each session began with a 5-minute warm-up followed by baseline tri-ple hop and vertical jump testing. Following baseline testing, tape with a “Y” cut was applied with 25% tension to the quadriceps muscle on the dominant leg in a distal-to-proximal or proximal-to-distal direction, and subjects were re-tested. Triple hop distance with the dominant leg and vertical jump height were measured over 3 trials. The mean and maxi-mum scores of the 3 trials were computed for each participant under each taping condition. One week later, subjects repeated all testing with tape applied in the direction opposite to their initial testing. The direction of tape application was randomized and subjects, testers and the data ana-lyst were blinded to the direction of tape application.RESULTS: Mean triple hop distance increased by 13.6 cm when taped prox-imal to distal, and decreased by 0.7 cm when taped distal to proximal (P = .046). Maximum triple hop distance increased by 9.4 cm when taped proximal to distal, and decreased by 3.8 cm when taped distal to proximal (P = .33). There were no significant baseline-taped differences in vertical jump scores according to taped condition.CONCLUSIONS: The results of this study suggest that the application of elas-tic tape may have an impact on hopping distance but not on jumping height. The direction of tape application was associated with hopping dis-tance. This is a pilot study and may not be powered by enough subjects to detect a minimal difference. These finds are interesting however and may be worth exploring in further studies.CLINICAL RELEVANCE: The effects seen in this study were small and limited to 1 of the functional tests. As a result, clinicians should remain skeptical of the claim that the application of elastic tape has an impact on lower ex-tremity functional performance.

OPO65THE USE OF DROPOUT CASTING IN A PATIENT WITH PERSISTENT KNEE FLEXION CONTRACTURE POST–ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONMelissa Dreger, Laura A. A. Schmitt, Airelle O. GiordanoPhysical Therapy, University of Delaware, Newark, DelawareBACKGROUND AND PURPOSE: Research has shown that loss of extension fol-lowing anterior cruciate ligament reconstruction (ACLR) may be relat-ed to limited preoperative extension and effusion [2]. Other factors that may also impact knee extension include concomitant injury and postin-jury stiffness [4]. However, treatment of those who have a loss of exten-sion has been limited in the research community, with very little evidence available on the use of dropout casting [1,3]. The purpose of this case study is to demonstrate the effectiveness of drop out casting in a patient with a loss of knee extension following ACLR.CASE DESCRIPTION: Patient is a 45-year-old woman who was initially seen preoperatively for L ACL tear, grade 2 MCL tear and medial meniscus tear. After failure to improve in her range of motion (ROM), she under-went surgical intervention with a knee flexion contracture (although not

recommended), including manipulation under anesthesia, ACLR with al-lograft, a partial meniscectomy, and synovectomy. At initial postoperative evaluation, impairments on the involved side included lacking 1° of knee extension to 55° of knee flexion, 28% quadriceps MVIC, and KOS ADL score of 20%. Although patient did make gains in knee ROM, quadriceps strength, and function over the initial postoperative 8 week period, her knee extension ROM began to regress (up to lacking 9°). After no reso-lution of flexion contracture for 2 weeks, a dropout cast was utilized for a total of 6 weeks to provide low-load long duration (LLLD) stretching to assist with improving knee extension ROM while physical therapy con-tinued to emphasize quadriceps strengthening and improved functional use of knee extension. Provided treatment included quadriceps strength-ening, NMES, gait training, and manual therapy. After she consistently presented with full knee extension between and during visits for 2 weeks, the cast was gradually weaned from use.OUTCOMES: Postoperatively, the patient was seen for a total of 50 visits over 24 weeks. At the first visit following initiation of the dropout cast-ing, patient demonstrated a 6° improvement in knee extension ROM that maintained for 8 visits over 2 weeks. The cast was remade after the LLLD stretching was no longer increasing range due to loosening at that time. Following a second casting intervention for an additional 8 visits over a 2-week period, patient demonstrated further improvement in ROM (3°-4°) that remained until discharge. From baseline to discharge, the patient made a 7° improvement (lacking 2°) in knee extension ROM overall. KOS ADL scores also made a clinically significant improvement to 79% follow-ing the implementation of the dropout cast while quadriceps strength also improved to 114% MVIC [5].DISCUSSION: This case study demonstrates the effectiveness of dropout casting in a patient with loss of knee extension following ACLR. However, additional research should be completed to determine the best parame-ters for usage and number of casts needed per person.REFERENCES: 1. Logerstedt D, Sennett B. Case series utilizing drop-out casting for the treatment of knee joint extension motion loss following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2007;37:404-411. 2. Mauro CS, Irrgang JJ, et al. Loss of extension fol-lowing anterior cruciate ligament reconstruction: analysis of incidence and etiology using IKDC criteria. Arthroscopy. 2008;24:146-153. 3. Pace JL, Nasreddine AY, et al. Dynamic splinting in children and adolescents with stiffness after knee surgery. J Pediatr Orthop. 2016. 4. Robertson, GA, Coleman SG, Keating JF. Knee stiffness following anterior cruci-ate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction. Knee. 2009;16:245-247. 5. Williams VJ, Piva SR, et al. Comparison of reliabil-ity and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. 2012;42:716-723.

OPO66THE USE OF A MODIFIED TENDON-LOADING PROGRAM IN A PATIENT WITH COMPLEX UNILATERAL ACHILLES TENDON REPAIRMelissa Dreger, Jennifer A. Zellers, Airelle O. Giordano, Karin G. SilbernagelPhysical Therapy Clinic, University of Delaware, Newark, Delaware; Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware; Department of Physical Therapy, University of Delaware, Newark, DelawareBACKGROUND AND PURPOSE: Acute Achilles tendon rupture is commonly treated via surgical repair. However, a serious complication to surgery is infection, with superficial wound infection occurring in 4% to 20% and deep wound infection in 1% to 2% of patients [1,4]. The most optimal treatment following postoperative wound infection is undescribed [4]. This case study describes the use of a comprehensive rehabilitation pro-gram including gradual tendon loading on a patient post–Achilles tendon repair complicated by deep wound infection.CASE DESCRIPTION: This case is a 63-year-old man 6 months post–Achilles


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tendon repair, followed by multiple debridements and wound vacuum (VAC) closure. The most recent debridement was 3 months prior to ini-tiation of physical therapy (PT). Diagnostic ultrasound imaging revealed an in-tact, hypoechoic tendon repair with osteotomy on the ruptured side and tendinosis on the nonruptured side. Upon initial evaluation, the pa-tient presented with weakness of the ankle musculature with an inabil-ity to perform a unilateral heel-rise. Limb symmetry indexes [LSI = (af-fected/unaffected) × 100%] showed 66% inversion, 78% eversion, and 79% dorsiflexion asymmetries [6]. Functionally, the patient reported moderate to severe disability evidenced by Victorian Institute of Sports Assessment-Achilles Questionnaire (VISA-A) score of 50/100 on nonrup-ture side, Achilles Tendon Total Rupture Score (ATRS) of 31/100 on rup-tured side, and Patient Specific Functional Scale (PSFS) average of 4/10 points [2,3,5]. The patient was seen by PT for 24 visits over 4 months. Rehabilitation emphasized gradual tendon loading, using a slow progres-sion of heel rises following the pain-monitoring model. Balance activities, gait retraining, and functional/neuromuscular electrical stimulation were also included in the patient’s plan of care.OUTCOMES: Midway through the patient’s PT course, ankle, inversion, eversion, and dorsiflexion LSI improved to 94%, 99%, and 104%, re-spectively. At discharge, the patient had a VISA-A score of 89/100, ATRS score of 57/100, and PSFS average score of 7/10. The patient was also able to complete the heel-rise test, performing 189 J total work, 7 repeti-tions, and maximum heel-rise height of 4 cm on ruptured and 906 J, 26 repetitions, and 6.7 cm maximum heel-rise height on nonruptured sides.DISCUSSION: A multimodal PT plan of care, incorporating gradual ten-don loading yielded positive functional outcomes, evidenced by improved clinical and patient self-reported outcomes, in an individual following Achilles tendon repair with a complex healing course.REFERENCES: 1. Bhandari M, Guyatt G, Siddiqui, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res. 2002;400:190-200. 2. Horn KK, Jennings S, et al. The Patient-Specific Functional Scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012;42:30-42. 3. Nilsson-Helander K, Thomee R, et al. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007;35:421-426. 4. Pajala, A, Kangas, J, et al. Rerupture and Deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84-A:2016-2021. 5. Robinson JM, Cook JL, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35:335-341. 6. Silbernagel KG, Nilsson-Helander K, et al. A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2010;18:258-264.

OPO67TIBIAL PLATEAU FRACTURE IN A PROFESSIONAL MUSICAL ATHLETE PARTICIPATING IN DRUM CORPS INTERNATIONAL: A CASE REPORTCarolyn A. Drislane, Cora Ray, Skye DonovanPhysical Therapy, Marymount University, Arlington, Virginia; Athletic Training, Western Kentucky University, Bowling Green, KentuckyBACKGROUND AND PURPOSE: Drum Corps International (DCI), beginning only 30 years ago, is the most popular activity of professional musical athletes today. Considered the “Marching Music’s Major League,” DCI has more than 5000 top musicians participate every year. With perform-ers ranging from 13 to 22 years in age, DCI is considered to be one of the fastest growing youth activities in America. Membership in DCI re-quires significant mental and physical strength, increased biomechanical demands directly related to performing with instruments while march-ing, and demanding time commitments. Performers may be at risk of sus-taining musculoskeletal injuries due to the repetitive nature of the ac-tivities performed during practice and performance. The most common

injuries are over-use injuries including stress fractures of the lower ex-tremity (hip, tibia, and metatarsals) and tendinopathy (dependent per-former’s instrument). The purpose of this case report is to describe the diagnosis of a closed transverse tibial plateau fracture in a musical ath-lete. Additionally, this case will highlight an area of emerging practice for physical therapists through the importance of screening professional mu-sicians, especially those in DCI, for biomechanical abnormalities to aid in prevention of injuries.CASE DESCRIPTION: This case report examines a 20-year-old male mello-phone player in Carolina Crown Drum and Bugle Corps. The subject was a healthy musician who had history of tibialis anterior tendinitis in the left leg 1 year prior to participation. No other medical issues were report-ed in the preseason physical performed by his primary care physician. At Crown, he rehearsed 8 to 10 hours a day, 7 days a week over 12 weeks. He was treated by a certified athletic trainer who was on site the entire season.OUTCOMES: Ten days before his final performance, the patient reported a constant dull pain in his L LE. After evaluation, his ATC gave an initial di-agnosis of tendinitis and performed conservative treatment: L tibial tap-ing, ice therapy after every rehearsal and show and ibuprofen as needed for pain. During his final performance, he fell over and was rushed off the field by sideline medics. The patient was taken to the emergency room where X-ray revealed a tibial plateau fracture. He immediately under-went surgery which included placement of intramedullary rod and screws to oppose the ends of the fracture. The patient recovered unsatisfactori-ly after initial operation due to mal-union of apposed fracture ends. The patient underwent a second surgery to correct and realign the injury. The patient recovered satisfactorily after second surgery and underwent phys-ical therapy to return to performing.DISCUSSION: This case report describes an extreme injury sustained dur-ing a single season of drum corps. Drum corps is a unique activity that would benefit from the involvement of physical therapists. By specializing in prevention, assessment, treatment and education of these athletes, bet-ter care can be provided and severe injury can be prevented.REFERENCES: 1. Moffitt DM, Russ AC, Mansell JL. Marching band camp in-jury rates at the collegiate level. Med Probl Perform Art. 2015;30:96-99. 2. Beckett S, Seidelman L, Hanney WJ, Liu X, Rothschild CE. Prevalence of musculoskeletal injury among collegiate marching band and color guard members. Med Probl Perform Art. 2015;30:106-110. 3. Kilanowski JF. Marching athletes: injuries and illnesses at band camp. MCN Am J Matern Child Nurs. 2008;33:338-345; quiz 346-347. 4. Hatheway M, Chesky K. Epidemiology of health concerns among collegiate stu-dent musicians participating in marching band. Med Probl Perform Art. 2013;28:242-251. 5. Steinmetz A, Màöller H, Seidel W, Rigotti T. Playing-related musculoskeletal disorders in music students-associated muscu-loskeletal signs. Eur J Phys Rehabil Med. 2012;48:625-633. 6. Kok LM, Vlieland TPV, Fiocco M, Nelissen RG. A comparative study on the preva-lence of musculoskeletal complaints among musicians and nonmusicians. BMC Musculoskelet Disord. 2013;14:9-15. 7. Guptill CA. The lived experi-ence of professional musicians with playing-related injuries: a phenome-nological inquiry. Med Probl Perform Art. 2011;26:84-95.

OPO68EFFECT OF FREE-SWING GAIT TRAINING ON BACK PAIN IN A PATIENT WITH BILATERAL AMPUTATION: A CASE REPORTCassie Duff, Megan FloresDoctor of Physical Therapy Program, University of St Augustine for Health Sciences, Austin, TexasBACKGROUND AND PURPOSE: Back pain is a common occurrence in per-sons with a lower extremity amputation, and can cause a chronic disabil-ity. Early prosthetic gait training can prevent patients with amputations from becoming disabled by chronic back pain. One technique for patients learning to walk with a prosthesis is free-swing gait training. This method of gait training includes unlocking the knee component of the prosthesis and leaving it unlocked throughout the gait cycle. Ambulation with an un-


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locked prosthesis requires the patient to exhibit confidence in his or her balance capabilities and ability to control where his or her weight is be-ing placed throughout the gait cycle. Free swing gait training has the po-tential to reduce the number of gait deviations these patients would nor-mally adopt during ambulation. However, there is a lack of evidence for the benefits of free-swing gait training on decreasing back pain. The pur-pose of this case study is to describe the effect of free-swing gait training on low back pain in a patient with bilateral lower extremity amputation.CASE DESCRIPTION: The patient was a 57-year-old Caucasian man with a history of left transtibial amputation and recent right transfemoral ampu-tation. He was referred to physical therapy for education on using his new transfemoral prosthetic and to improve functional independence. One of his chief complaints was debilitating low back pain that had increased since his latest amputation. It was hypothesized that the normalization of the patient’s gait pattern through free-swing gait training would decrease his complaint of back pain.OUTCOMES: Upon initial evaluation, the patient reported pain of 6/10 in both shoulders and low back, as measured by the Numerical Rating Scale. The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) was administered to assess the patient’s self-confidence when performing different functional activities. He scored a 34/60 on the initial OPTIMAL, indicating he felt approximately 60% impaired with his ability to perform daily activities in his home and in the community. After 8 weeks of physical therapy, including 3 weeks of free-swing gait train-ing, the patient’s OPTIMAL score decreased to 20/60, indicating he felt more confident being able to perform functional activities out in the com-munity. Additionally, he reported a decrease in bilateral shoulder and low back pain to 0/10. The patient also improved with ambulation from an ini-tial distance of 50 ft with a rolling walker and physical assistance, to 300 ft with a rolling walker independently utilizing a free-swing gait pattern.DISCUSSION: After an intervention of free-swing gait training, the patient demonstrated decreased low back pain, increased strength, and improved gait quality and distance. The results of this case report demonstrate that the use of free-swing gait training can be beneficial to decrease back pain in a patient with bilateral amputation.REFERENCES: Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89:422-429. Pasquina PF, Miller M, Carvalho AJ, et al. Special considerations for multiple limb amputation. Curr Phys Med Rehabil Rep. 2014;2:273-289. Prinsen EC, Nederhand MJ, Rietman JS. Adaptation strategies of the lower extremities of patients with a transtibial or transfemoral ampu-tation during level walking: a systematic review. Arch Phys Med Rehabil. 2011;92:1311-1325. Gailey R. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil Res Dev. 2008;45:15-30. Devan H, Hendrick P, Ribeiro DC, Hale L a, Carman A. Asymmetrical movements of the lumbopelvic re-gion: is this a potential mechanism for low back pain in people with low-er limb amputation? Med Hypoth. 2014;82:77-85. Bae TS, Choi K, Hong D, Mun M. Dynamic analysis of above-knee amputee gait. Clin Biomech (Bristol, Avon). 2007;22:557-566. Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dys-vascular lower-limb amputations. Arch Phys Med Rehabil. 2005;86:480-486. Ehde DM, Czerniecki JM, Smith DG, et al. Chronic phantom sen-sations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil. 2000;81:1039-1044. Kulkarni, J, Gaine, WJ, Rankine, JJ, Adams J. Chronic low back pain in traumatic lower limb amputees. Clin Rehabil. 2005;19:81-86. Williamson A, Hoggart B. Pain: a review of 3 commonly used pain rating scales. 2005;1994 (Spence 2000):798-804. Guccione AA, Mielenz TJ, Robert F, et al. Research report development and testing of a self-report instru-ment to measure actions: Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL). Phys Ther. 2005;85:515-530.

OPO69MOVEMENT AND SUSTAINED FUNCTIONAL ACTIVITY NECK PAIN RATINGS: A USEFUL ADDITION TO MEASURE IMPROVEMENT?Kim Dunleavy, Charles W. Gay, Mark BishopPhysical Therapy, University of Florida, Gainesville, FloridaPURPOSE/HYPOTHESIS: Neck pain is common disorder managed by physical therapists. However, there is a need for additional intermediate measures of clinical improvement in disability for clinicians to monitor progress. Range of motion and motor control are weakly associated with disability, and resting pain is only moderately related to disability. Measures of move-ment-related pain account for unique variance in self-reported disability, beyond the variance accounted for by a traditional measure of neck pain suggesting these additional specific pain-related metrics may be more sen-sitive to track clinical improvement. Therefore, the purpose of this study was to investigate whether fluctuations in pain related to movement and sustained positions account for unique fluctuations in self-reported dis-ability not accounted for by traditional measures of pain intensity.NUMBER OF SUBJECTS: Eighty-seven people with moderate (approximately 3/10) chronic mechanical neck pain (mean ± SD age, 56 ± 8 years; 85% female; NDI, 13 ± 6) completed 18 weeks of self-reported disability, inten-sity of neck pain, pain with movement, and pain with sustained activities.MATERIALS/METHODS: Secondary analysis of data collected for a therapeutic exercise intervention study. Disability was assessed with the neck disabili-ty index (NDI). Spontaneous pain intensity, pain with movement (person-al care, lifting, overhead activities, meal prep, housework) and sustained activities (driving, reading, computer use, sleeping, work, sitting, stand-ing) were assessed using 11-point numeric rating scales. Multilevel mod-eling for change was used to address within-person and between-person questions about changes in NDI simultaneously. NDI was the dependent variable in all models with neck pain intensity, age, and treatment group included as baseline model predictors. Subsequent models included the same predictors and added measures of movement-evoked pain. A final parsimonious model was constructed with significant (P<.05) pain char-acteristic predictors.RESULTS: The baseline model explained 39% of the variance in NDI. The final parsimonious model (–2LL = 3964, AIC = 3974, BIC = 3998) ex-plained 47% of the variance in NDI and showed a significant improve-ment in model fit statistics (χ2 = 350, df = 2, P<.01) compared to the base-line model.CONCLUSIONS: The final model showed that fluctuations in disability covar-ied with the intensity of spontaneous pain and pain with sustained activi-ties while the intensity of movement-evoked neck pain explained individ-ual differences in the trajectory of disability improvement. These results suggest that pain related to movement and sustained activities represent disability-relevant dimensions of neck pain not captured by traditional measures of spontaneous pain.CLINICAL RELEVANCE: Movement and sustained activity- related pain rat-ings are a useful, fast and simple, additional measure for clinicians to as-sess. Fluctuations in activity-specific pain help explain variations in pa-tient disability over time and distinguish between patients and may be useful for clinicians to assess intermediate changes.

OPO70EPIDEMIOLOGY OF HIP FLEXOR AND ADDUCTOR STRAINS IN NATIONAL COLLEGIATE ATHLETIC ASSOCIATION ATHLETES, 2009/10-2014/15Timothy Eckard, Zachary Y. Kerr, Darin Padua, Thomas P. Dompier, Aristarque DjokoHuman Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Datalys Center for Sports Injury Research and Prevention, Indianapolis, IndianaPURPOSE/HYPOTHESIS: The purpose of this study was to describe the epide-miology of hip flexor and adductor strains across 25 NCAA championship


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sports during the 2009-2010 to 2014-2015 academic years.NUMBER OF SUBJECTS: Six hundred nineteen hip flexor and 464 hip adduc-tor strains.MATERIALS/METHODS: The NCAA Injury Surveillance Program (NCAA-ISP), a prospective injury surveillance program, utilized a convenience sample of NCAA varsity teams from 25 sports with athletic trainers re-porting injury data. Rates and patterns of hip flexor and adductor strains sustained during collegiate sports were examined. Analyses included strain rates and distributions of injuries by injury mechanism, recurrence, and participation restriction time. Injury rate ratios (IRRs) were calcu-lated to compare rates within sports by event type and to compare over-all rates by sex among sex-comparable sports. Injury proportion ratios (IPRs) were calculated to examine sex differences in injury mechanism, recurrence, and participation restriction time in sex-comparable sports. All 95% confidence intervals (CIs) not including 1.00 were considered statistically significant.RESULTS: Six hundred nineteen hip flexor and 464 hip adductor strains oc-curred in the study period, representing overall injury rates of 1.26/10 000 athlete-exposures (AE) and 0.96/10 000 AE, respectively. The majority of hip flexor (73.1%) and adductor strains (72.9%), occurred in practic-es, though both had higher rates in competition (hip flexor 1.38 versus 0.85/10 000 AE; IRR = 1.63; 95% CI: 1.33, 2.00); (hip adductor 1.86 ver-sus 1.13/10 000 AE; IRR = 1.65; 95% CI: 1.38, 1.97). Among sex-compa-rable sports, the hip flexor strain rate was higher in men than women (1.51 versus 0.97/10 000AE: IRR = 1.56; 95% CI: 1.28, 1.90), with no difference between the sexes in rate of hip adductor strains (0.89 versus 0.76/10 000 AE; IRR = 1.18; 95% CI: 0.93, 1.49). Noncontact was the mechanism for most hip flexor (62.4%) and adductor strains (65.7%); 11.1% of hip flexor strains, and 11.4% of adductor strains, were recurrent. 80.0% of hip flex-or strains and 82.3% of adductor strains resulted in less than 1 week of participation restriction, and over 50% of each were NTL. No differences were found between sex-comparable sports in mechanism, recurrence, or participation restriction.CONCLUSIONS: The majority of hip flexor and adductor strains occurred in practice, were due to noncontact, and resulted in less than 1 week partic-ipation restriction. In sex-comparable sports, men experienced a higher rate of hip flexor, but not adductor, strains than women, and no differ-ences were found in mechanism, recurrence, or participation restriction.CLINICAL RELEVANCE: This study provides a baseline from which to develop improved recommendations for the prevention and rehabilitation of hip flexor and adductor strains that are both sport- and mechanism-specific. Evaluating the effectiveness of prevention programs is not possible with-out accurate baseline data.

OPO71EPIDEMIOLOGY OF QUADRICEPS STRAINS IN NATIONAL COLLEGIATE ATHLETIC ASSOCIATION ATHLETES, 2009/10-2014/15Timothy Eckard, Darin Padua, Aristarque Djoko, Thomas P. Dompier, Zachary Y. KerrHuman Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Datalys Center for Sports Injury Research and Prevention, Indianapolis, IndianaPURPOSE/HYPOTHESIS: This study was designed to describe the epidemi-ology of quadriceps strains in collegiate athletics during the 2009-2010 to 2014-2015 academic years utilizing a convenience sample of NCAA programs from 25 sports during the 2009-2010 to 2014-2015 academ-ic years.NUMBER OF SUBJECTS: Five hundred twelve quadriceps strains.MATERIALS/METHODS: The NCAA Injury Surveillance Program (NCAA-ISP), a prospective injury surveillance program, utilized a convenience sample of NCAA varsity teams from 25 sports with athletic trainers re-porting injury data. Data were analyzed to assess rates and patterns of quadriceps strains sustained during collegiate sports. Analyses included

quadriceps strain rates and distributions of injuries by injury mechanism, recurrence, and participation restriction time. Injury rate ratios (IRRs) were calculated comparing rates within sports by event type and time in season. IRRs were also used to compare overall rates by sex among sex-comparable sports. Injury proportion ratios (IPRs) were calculated to ex-amine sex differences in distributions of injury mechanism, recurrence, and participation restriction time. All 95% confidence intervals (CIs) not including 1.00 were considered statistically significant.RESULTS: The overall rate of quadriceps strains during the study period was 1.04/10 000 athlete-exposures (AE). The sports with the highest rates were women’s soccer (5.57/10 000 AE), men’s soccer (2.49/10 000 AE), and women’s softball (2.12/10 000 AE) Across sex-comparable sports, women had a higher rate of quadriceps strains than men overall (1.91 ver-sus 0.63/10 000 AE: IRR = 3.03; 95% CI: 2.44, 3.76). The majority of quadriceps strains (77.9%) were sustained during practice. However, the rate was higher during competition (1.25 versus 1.00/10 000 AE; IRR = 1.25; 95% CI: 1.02, 1.54). Most quadriceps strains (57.8%) occurred in the preseason and rates were significantly higher during the preseason than the regular season (2.23 versus 0.62/10 000 AE; IRR = 3.60; 95% CI: 3.02, 4.31). Common injury mechanisms included noncontact (62.9%) and overuse (22.1%). Most quadriceps strains (79.9%) resulted in partici-pation restriction time less than 1 week.CONCLUSIONS: Across 25 sports, higher quadriceps strain rates were found in females versus males, in competitions versus practices, and in the pre-season versus the regular season. The incidence of quadriceps strains in NCAA athletics was lower than hamstring strains but higher than other strains in the lower extremities. Most quadriceps strains resulted in par-ticipation restriction under 1 week.CLINICAL RELEVANCE: This study provides a baseline from which to de-velop improved recommendations for the prevention and rehabilita-tion of quadriceps strains that are both sport- and mechanism-specific. Evaluating the effectiveness of prevention programs is not possible with-out accurate baseline data.

OPO72DIFFERENCES BETWEEN DYNAMIC FUNCTIONAL TESTING AND PRESSURE PAIN THRESHOLD VALUES IN FEMALE DISTANCE RUNNERS WITH AND WITHOUT A PRIOR INJURY HISTORYBrian J. Eckenrode, Tara Chadwick, Justin Gardner, Lauren NederostekPhysical Therapy, Arcadia University, Glenside, PennsylvaniaPURPOSE/HYPOTHESIS: A prior injury history and being female has been shown to be associated with an increased risk for sustaining a running-re-lated injury (RRI). These overuse injuries can frequently recur or become chronic. Muscle weakness, temporal parameters, and altered biomechan-ics have been described as potential contributors to RRIs. Recently theo-rized, individuals with greater localized hyperalgesia from chronic lower extremity conditions may also exhibit altered lower extremity mechanics from increased nociceptive input. The purpose of this pilot study was to investigate differences between dynamic functional testing and pressure pain threshold (PPT) values in female distance runners with and without a prior injury history.NUMBER OF SUBJECTS: Sixteen female runners (mean ± SD age, 23 ± 3.4 years) were recruited from the local university community. Inclusion cri-teria consisted of running a minimum of 1.5 hours per week for at least 6 weeks prior to testing. Subjects had a mean ± SD body mass index of 24.02 ± 2.12 kg/m2, and had reported running for a mean 7.11 ± 3.74 years at an average of 18.89 ± 9.40 mi/wk.MATERIALS/METHODS: A running activity and injury questionnaire, Pain Catastrophizing Scale, and Lower Extremity Functional scale was com-pleted by all subjects prior to testing. Functional performance testing was assessed via the Y Balance Test (YBT), and PPT was quantified at 6 dif-ferent lower extremity sites bilaterally with a digital pressure algometer.RESULTS: Of the 16 subjects, 8 had reported a prior history of lower ex-


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tremity injury requiring time off from running and medical treatment. No significant differences were found between prior injury history and run-ning pace, running volume, or years running. There was a significant dif-ference for runners with an injury history to have a greater than 4 cm side to side difference on the YBT (P = .009), in addition to a significant dif-ference for YBT absolute difference between extremities (P = .030). For PPT, no significant difference in pain threshold values between groups was found. There was a fair to moderate correlation (ICC range, 0.46-0.62) between YBT composite score and PPT at both the distal tibia and patella retinaculum in this group of runners.CONCLUSIONS: Female runners with a prior history of lower extremity in-jury exhibited greater asymmetry with dynamic functional testing com-pared to the uninjured group. While no significant differences were found between groups for PPT values in the lower extremity, there was a fair to moderate association between YBT scores and PPT of the distal tibia and patella retinaculum. Further investigations should expand on the rela-tionship between lower extremity functional performance and running mechanics on PPT.CLINICAL RELEVANCE: Female distance runners with a prior history of a RRI may exhibit continued deficits in dynamic functional testing. The rela-tionship between nociceptive changes and functional performance in should be considered in the management of those runners with a prior injury history.

OPO73ANODAL TRANSCRANIAL DIRECT-CURRENT STIMULATION RESULTS IN INCREASED MAXIMUM ISOMETRIC TRUNK EXTENSOR STRENGTH IN HEALTHY SUBJECTSEmily Ellerbrock, Cody Chabola, Megan E. Applegate, Gabrielle Hausfeld, Jacob Magary, James S. ThomasRehabilitation and Communication Sciences, Ohio University, Athens, OhioPURPOSE/HYPOTHESIS: Direct medical costs for low back pain exceed $90 billion per year in the United States, driven primarily by 10% of patients who develop chronic low back pain (cLBP). Existing treatments for cLBP pain have proven to be of limited benefit to reduce disability and improve function. The purpose of this study was to investigate the effects of an-odal transcranial direct current stimulation (tDCS) on trunk extensor strength. Anodal tDCS treatment has been shown to increase strength in arm muscles, but its effects on isometric trunk extensor strength are unknown. Accordingly, trunk extensor strength was tested during 20 minutes of tDCS treatment and for 40 minutes after treatment in both healthy control (HC) and cLBP subjects.NUMBER OF SUBJECTS: Seventeen subjects (8 HC and 9 cLBP) aged 20 to 44 years.MATERIALS/METHODS: Subjects attended 2 sessions. Baseline maximum iso-metric trunk extensor force was tested using a MedX core trunk exten-sion device custom fitted with a single DOF load cell (Load Cell Central). Subjects were seated with a neutral spine position, 90° of hip flexion, and 60° of knee flexion, and were instructed to push back into the backrest. Subjects received visual feedback displaying their max force and cur-rent force on a computer screen and verbal encouragement was provid-ed using a digital recording to ensure uniformity. Subjects then received a 20-minute treatment of either sham or anodal tDCS (subjects and re-searchers were blinded to treatment order) at 2-mA intensity with a 30 second ramp up and ramp down. During sham tDCS, subjects received only the ramp up and ramp down. The 2 × 2-inch stimulating electrode was positioned on a saline soaked sponge over the central sulcus of M1; the cathode was placed on the right side of the forehead. Every 10 minutes during the session, participants performed a maximum isometric trunk extension.RESULTS: The cLBP group generated lower peak isometric extension force compared to HC (P<.05). There was a main effect of treatment (anodal, sham) on peak isometric extensor force (P = .014) and a trend for an in-

teraction of group (cLBP, HC) by treatment (P = .062). Follow up analy-ses revealed a single treatment of anodal tDCS resulted in increased trunk extensor force compared to sham only for HC (P<.001). Although statis-tically insignificant, trunk extensor force was larger during anodal tDCS compared to sham in the cLBP group.CONCLUSIONS: These preliminary results indicate that anodal tDCS placed over the central sulcus for 20 minutes can result in increased back exten-sion strength up to 40 minutes posttreatment in HC, which may have po-tential use as an adjunct to trunk extension exercises in order to maxi-mize force generation.CLINICAL RELEVANCE: This study has revealed the potential for anodal tDCS to be used to increase motor function resulting in increased trunk exten-sor force in healthy individuals. The next step in this research will be to determine how anodal tDCS can be used to improve motor function and ultimately reduce disability in a larger population of people with cLBP.

OPO74MUSCLE QUALITY MATTERS: TRANSLATION OF MUSCLE FAT INFILTRATION ANALYSIS TO CLINICAL PRACTICE AND BIOMECHANICAL MODELINGJames M. Elliott, Anneli Peolsson, Janne West, Rebecca Abbott, Ulrika Åslund, Anette Karlsson, Olof Dahlqvist LeinhardPhysical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois; Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden; Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Biomechanical Engineering and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, SwedenPURPOSE/HYPOTHESIS: Increased muscle fat infiltration (MFI) is related to poor functional recovery following whiplash. However, the complexity and time constraints of a quantitative analysis of MRI images may hinder translation into radiology clinical practice and interdisciplinary research. We employed a qualitative metric for magnitude and distribution of MFI in the cervical multifidus muscle using fat/water MRI. We assessed the ability of this method to predict clinical presentation. Additionally, we demonstrate the value of the resulting muscle quality data to explore the functional consequences of muscle degeneration in a biomechanical mod-el of the neck.NUMBER OF SUBJECTS: Thirty-one subjects (14 male, 17 female; mean ± SD age, 41.5 ± 10.6 years; range, 22-61 years) and 31 age- and sex-matched healthy controls were recruited from a randomized controlled trial at baseline. Inclusion criteria included neck disability index (NDI) of great-er than 20% at 3 months to 3 years postcollision. Three study groups were controls, mild/moderate WAD (NDI greater than 20%, less than 40%), and severe WAD (NDI greater than 40%). The local ethics com-mittee approved the study, and written informed consent was obtained from all participants.MATERIALS/METHODS: Phase sensitive reconstruction of the data were per-formed and the multifidus was identified and segmented by a blinded op-erator in the fat/water images (C4-C7), using Analyze 11.0 (AnalyzeDirect, USA). The multifidus muscle was manually divided in 8 equally sized re-gions. MFI was visually graded according to: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. Statistical analysis was performed in SPSS 19 (IBM, 2010). Data characterizing the spatial distribution of MFI in the severe, mild/moderate, and control groups was used to specify muscle parameters in a computational neck model.RESULTS: Twenty-one (68%) of the patients had mild to moderate disabil-ity and 10 (32%) had severe disability. Statistically significant differences in the overall frequency of a grade 2 were found between healthy controls and severe WAD (P = .03) and between mild/moderate and severe WAD (P = .03). The ROC analyses indicated fair (AUC = 0.768) discrimination between the severe versus mild/moderate WAD groups when considering frequency of distinct (grade 2) MFI.CONCLUSIONS: The distribution of MFI agreed with previous work showing


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greater fat along the medial and anterior regions of the multifidus mus-cle in all groups, with globally elevated MFI in the severe WAD group. Predictions from the biomechanical model highlight potential differenc-es in muscle activation patterns and joint stresses due to the specific spa-tial distribution of MFI in severe WAD.CLINICAL RELEVANCE: The complexity of methods for measuring quantita-tive MFI has been a barrier to translation into clinical practice and cross-disciplinary research (eg, biomechanics). With translation in mind, this study proposes a novel qualitative MR method for grading degeneration in neck muscles and demonstrates an example of its use in a biomechani-cal modeling application.

OPO75HEIGHTENED PAIN SENSITIVITY AND INEFFICIENT ENDOGENOUS PAIN MODULATION IN PATIENTS WITH OROFACIAL PAIN: A LONGITUDINAL STUDYCarla S. EnriquezRehabilitation and Movement Science, Rutgers, The State University of New Jersey, Newark, New JerseyPURPOSE/HYPOTHESIS: We aimed to investigate if heightened pain sensitivi-ty [1] is associated with inefficient endogenous pain modulation [2] using quantitative sensory testing (QST) [3,4,5] in patients with orofacial pain.NUMBER OF SUBJECTS: Forty.MATERIALS/METHODS: A convenience sample of subjects (n = 40) with oro-facial pain seen for an initial visit at a specialized orofacial pain clinic were assessed for individual pain processing mechanisms using QST [3]. Pain sensitivity was assessed through Temporal Summation (TS) [3,4] while endogenous pain modulation through Conditioned Pain Modulation (CPM) [3,5] testing protocols. These procedures were administered pri-or to the subjects receiving any intervention, where baseline demograph-ics, psychological variables, and self-reported disability scores were also collected. Psychological variables were measured using physical activity and work subscales of the Fear-Avoidance Beliefs Questionnaire (FABQ). The numeric pain-rating scale was used for QST pain ratings and the Therapeutic Associates Outcomes Scale (TAOS) was used for self-report-ed disability measure. Pearson correlation analyses were conducted on TS and CPM scores, as well as self-reported psychological and disabili-ty measures.RESULTS: A strong positive correlation was found between increased pain sensitivity and inefficient endogenous inhibitory pain modulation activi-ty in patients with orofacial pain (r = 0.69, P<.001). A moderate negative correlation was also found between FABQ physical activity subscale and self-reported disability scores (r = –0.43, P = .006); and FABQ work sub-scale and self-reported disability (r = –0.39, P = .012). Results of our study suggest that increased pain sensitivity is associated with marked deficien-cy in endogenous pain modulation system as measured through QST in patients who seek treatment for orofacial pain. It also appears that self-re-ported disability scores does not directly correlate with psychological fac-tors on FABQ in these patients.CONCLUSIONS: Our study was able to demonstrate a strong and direct cor-relation between heightened pain sensitivity and inefficient endogenous pain modulation in patients with orofacial pain. Furthermore, psycholog-ical factors did not appear to directly correlate with self-reported disabil-ity in this patient population.CLINICAL RELEVANCE: Identification of factors that contribute to the cause and persistence of orofacial pain is an important research goal, as it is a preliminary step towards developing effective interventions in these in-dividuals. Quantitative Sensory Testing provides direct and quantitative measure of individual pain processing mechanisms essential in under-standing the etiology and associated impairments and limitations with orofacial pain. Future studies should support or refute these findings and investigate the nature of these associations to create effective intervention strategies in this patient population.

OPO76SEX-SPECIFIC KINETIC AND KINEMATIC INDICATORS OF MEDIAL TIBIOFEMORAL FORCE DURING RUNNINGJean-Francois Esculier, Richard W. Willy, Michael Baggaley, Stacey A. Meardon, John D. WillsonLaval University, Quebec, Quebec, Canada; East Carolina University, Greenville, North CarolinaPURPOSE/HYPOTHESIS: Maintaining an active lifestyle while avoiding ex-cessive joint loading is recommended for individuals with medial tibio-femoral joint (TFJ) osteoarthritis (OA) [1]. During walking, lower medi-al TFJ force can be achieved by decreasing peak knee adduction moment (pKAM) and knee flexion moment (pKFM) [2,3]. However, the contri-bution of pKAM and pKFM to medial TFJ force during running is not known. Additionally, clinically modifiable kinematic variables to de-crease peak medial TFJ force during running have yet to be identified. Differences in running mechanics between males and females raise the possibility that contributions to medial TFJ force are sex-specific [4]. Thus, the goals of this study were to (1) evaluate the sex-specific contribu-tion of pKFM and pKAM to medial TFJ force during running; (2) iden-tify sex-specific kinematic variables that can be measured in the clinic to estimate and modify peak medial TFJ loads.NUMBER OF SUBJECTS: Eighty-seven healthy runners (36 female, 51 male; mean ± SD age, 23.0 ± 3.8 years).MATERIALS/METHODS: Three-dimensional kinematic and kinetic data were collected during treadmill running at preferred speed (3.0 ± 0.4 m/s). Peak medial TFJ contact force was estimated using a validated muscu-loskeletal model [5]. Linear regression analyses were used to assess the contribution of kinetic (pKFM, pKAM) and kinematic variables to esti-mated peak medial TFJ force. Clinically modifiable kinematic variables of interest included sagittal and frontal knee, ankle and foot kinematics as well as step rate, step length, foot progression angle and center of mass (COM) vertical displacement.RESULTS: In the whole cohort, the combination of pKAM and pKFM explained 64.5% of peak medial TFJ force variance during running (P<.001). Together, both variables accounted for 79.5% of peak medi-al TFJ force in females, and 73.8% in males (P<.001). However, pKAM contribution was only 26.8% in females compared to 50.4% in males. Analyses also revealed sex-specific kinematic predictors of peak medi-al TFJ force during running. In females, lower ankle dorsiflexion at foot strike and center of mass (COM) vertical displacement best predicted lower peak medial TFJ force (R2 = 0.364, P = .012). In males, greater peak knee abduction angle and shorter step length best predicted lower medial compartment force (R2 = 0.508, P = .019).CONCLUSIONS: Our results suggest that pKAM and pKFM make signifi-cant but potentially sex-specific contributions to peak medial TFJ forces during running. Clinicians seeking reductions in peak medial TFJ force through running retraining interventions should aim for reduced ankle dorsiflexion at foot strike and COM vertical oscillation in females, and greater knee abduction and shorter step length in males.CLINICAL RELEVANCE: These results provide insights on modifiable kinemat-ic variables that can be addressed in the clinic to decrease medial TFJ force during running. Targeting identified predictors through running gait modifications may help physical therapists in treating their patient runners with symptomatic medial TFJ OA.

OPO77FOR INDIVIDUALS WITH NONCONTACT ACL RUPTURE, IS THERE EVIDENCE OF HIP ROTATION RANGE-OF-MOTION LIMITATIONS? A LITERATURE REVIEWMelanie Eskin, Kathleen Esler, Kelly Haspel, Julie Lezak, Katelyn Miele, Christopher Salaga, Tyler Smith, Daniel Spinelli, Allison M. BrownRutgers, The State University of New Jersey, Newark, New JerseyPURPOSE/HYPOTHESIS: Anterior cruciate ligament (ACL) ruptures occur


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frequently and with high financial implications. It is estimated that 80% of ACL ruptures occur through a noncontact mechanism [1]. Studies have suggested that limited range of motion, specifically hip internal rotation, is a risk factor for noncontact ACL ruptures [2]. The purpose of this re-view is to determine whether there is evidence to support an association between hip rotation range of motion (ROM) limitations and noncon-tact ACL rupture.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: Web of Science and PubMed were searched using the following search terms: ACL AND hip range; ACL risk AND hip range; ACL AND hip rotation; ACL AND hip; ACL risk factor. Studies were in-cluded if they examined healthy individuals, aged 13 to 65 years with non-contact ACL rupture. Additionally, studies using goniometric measures of hip rotation range of motion and those written in the English language were included. Studies were excluded if they examined participants with lower extremity pathologies other than ACL rupture, participants with contact ACL rupture, hip rotation range of motion measured during func-tional tasks or cadaveric studies.RESULTS: Six articles met the inclusion criteria [2-7]. All studies were cross sectional by design, with male and female participants ranging from 13 to 40 years old. Studies included both athletes and nonathletes alike; how-ever, a majority of the participants were male soccer players. Overall, par-ticipants with a limited sum of hip rotation range of motion had great-er odds of having a history of ACL rupture compared to those without ACL rupture. Additionally, these studies suggested there was a statisti-cally significant decrease in hip internal rotation range of motion among participants with ACL rupture compared to control participants. With the exception of 2 studies [2,3], there was no significant difference in hip ex-ternal rotation range of motion differences between groups.CONCLUSIONS: The results suggest that subjects with decreased hip rota-tion beyond a predetermined threshold, mainly due to internal rotation limitations, are at greater odds of having a history of ACL rupture. This is consistent with the theory that insufficient range of motion at the hip transfers rotational forces to the knee joint, thereby increasing stress on the ACL. Our review is limited in that the most at-risk population (eg, fe-males and adolescents) are not represented.CLINICAL RELEVANCE: Patients with a history of noncontact ACL rupture are at greater odds of presenting with limited hip rotation ROM, specifical-ly in internal rotation. Clinicians should screen and consider hip rota-tion ROM when designing ACL prevention and rehabilitation programs.

OPO78CLINICAL PERSPECTIVE ON THE USE OF PAIN CLASSIFICATION AND CLINICAL OUTCOMESMemrie D. Ferguson, Janna M. McGaughDepartment of Physical Therapy, The University of Texas Medical Branch, Galveston, TexasPURPOSE/HYPOTHESIS: Appropriate identification of pain type should en-able the clinician to select interventions hypothesized to target specific mechanisms involved in pain signal generation and maintenance, influ-encing clinical outcomes. Current evidence suggests 3 clinically mean-ingful categories exist for musculoskeletal pain: nociceptive pain (NP), peripheral neuropathic pain (PNP), and central sensitization (CS). The purpose of this pilot study was to investigate the utilization of a Pain Classification Tool (PCT) in determining pain type and associated out-comes in an outpatient clinical practice setting.NUMBER OF SUBJECTS: Two licensed physical therapists utilized a PCT to identify pain type and track outcome data in 72 patients who were re-ferred to an orthopaedic physical therapy clinic with complaints of mus-culoskeletal pain over an 8-month period.MATERIALS/METHODS: The PCT included 32 criteria defining symptom na-ture, duration, behavior, and severity in addition to physical signs and patient beliefs. The criteria were divided into 1 of 3 categories (NP, PNP, CS) and organized as a checklist based on best evidence and current un-

derstanding of neurophysiology. Criteria includes 8 suggestive of NP, 5 of PNP, and 9 of CS. Additional outcomes include duration of physical ther-apy episode of care, number of visits, and therapist-selected standardized outcome measures assessed at the initial and discharge encounter.RESULTS: A PCT was utilized in 72 patients to identify the primary pain type and the impact of pain type on treatment outcomes, including to-tal number of visits, duration of care, and presence of clinically meaning-ful outcomes. Thirty-nine patients (54.2%) were identified as NP type, 25 (34.7%) were identified as PNP type, and 8 (11%) were identified as CS pain type. Patients with NP type received an average of 6.8 treatment ses-sions over a 31.4 day period with 29 of 39 reporting clinically meaning-ful outcomes (74.4%). Patients with PNP received an average of 9.1 treat-ment sessions over a 43.1-day period with 17 of 25 reporting clinically meaningful outcomes (68%). Patients with CS pain type received an aver-age of 12.4 treatment sessions over a 101.4-day period, with 4 of 8 (50%) reporting clinically meaningful outcomes.CONCLUSIONS: This pilot study offers insight on the impact of pain clas-sification on treatment outcomes. NP was the most frequently encoun-tered pain type, requiring the least number of visits, the shortest dura-tion of care, and the highest outcome of clinically meaningful change. PNP ranks second in all measured outcomes. CS was the least encoun-tered pain type requiring most number of visits, longest duration of care, and lowest outcome of clinically meaningful change. Further research is necessary to establish validity of the tool and impact of symptom classi-fication on outcomes.CLINICAL RELEVANCE: Implementation of a pain classification tool may pro-vide valued decision making in clinical care influencing the utilization and duration of physical therapy services as well as the presence of clinically meaningful outcomes in patients with musculoskeletal pain presentations.

OPO79INFLUENCE OF NEUROMUSCULAR CONTROL AND STRENGTH TRAINING OF CORE MUSCULATURE ON DISTAL FUNCTION: A SYSTEMATIC REVIEWRichard Ferraro, Alexandria Achille, Andrew Frazzini, Sarah J. Garman, Seth C. Gentile, Adam C. HuynhRutgers University, Stratford, New JerseyPURPOSE/HYPOTHESIS: The purpose of this review was to identify and dif-ferentiate the effects of neuromuscular and strength training of core mus-culature on distal function.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: A comprehensive search was performed using PubMed, CINAHL, MEDLINE, and Google Scholar databases. Search terms included combinations such as: “Transversus Abdominis” AND “Daily Activities,” “TrA” AND “Activation,” and “TrA” AND “Strength.” This review targeted randomized control trials and cohort studies. Sackett (2000) ratings were used for initial inclusion assessing article eligibili-ty. All remaining articles were then scored for internal validity by at least 2 reviewers using the MacDermid (2004) scoring (0-48 point scale). Discrepancies in scores were reviewed by all authors to achieve consen-sus for a final score.RESULTS: Nine articles met our standards for inclusion in this review (lev-el of evidence: 1 article, 1b; 8 articles, 2b). MacDermid scores ranged from 25 to 39, with a mean of 30. Interestingly, results of the review were evenly split yielding 4 studies that proposed using neuromuscular training tech-niques, 4 supported strength training and 1 study supported both interven-tion strategies for augmenting various aspects of distal extremity function.CONCLUSIONS: Based on the evidence, both neuromuscular and strength training of the transverse abdominis and surrounding core musculature have beneficial effects when they are included in treatments aimed at im-proving gait and upper and lower extremity function. However, the mech-anism of application and time required to reach desired effects of each of these approaches is often very different. Future research in this area should make efforts to delineate the long term effects of the aforemen-tioned interventions, increase size and diversity of the populations be-


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OPO81INTEREXAMINER RELIABILITY OF THE MYOMETER TO MEASURE ACHILLES TENDON BIOMECHANICAL PROPERTIES AND CORRELATION WITH A FUNCTIONAL CALF-LENGTH TESTJacquelyn Fletcher, Spenser Studebaker, Stuart J. Warden, Amy J. BaylissPhysical Therapy, Indiana University, Indianapolis, IndianaPURPOSE/HYPOTHESIS: In vivo Achilles tendon mechanical properties have traditionally been estimated using a combination of real-time diagnos-tic imaging and dynamometry. The approach provides measures such as Achilles tendon stiffness and Young’s modulus, but is labor and resource intensive reducing its clinical utility. Myometry is a newer technique that utilizes a simple handheld, portable instrument to provide quick and non-invasive measures of the mechanical properties of soft tissue. The aim of the current work was to begin exploring the clinical utility of myome-try measures of the Achilles tendon by assessing their: (1) short-term be-tween-examiner precision, and (2) correlation with a clinical measure of Achilles length.NUMBER OF SUBJECTS: Twenty-seven adults, 54 tendons (mean ± SD age, 24.4 ± 1.1 years; 52% male).MATERIALS/METHODS: Healthy young subjects between 20 and 30 years old were recruited. Subjects were excluded if they reported: (1) pain in the ankle or heel, (2) a history of Achilles tendon rupture or surgery, or, (3) foot or ankle surgery in the past 12 months. A MyotonPro myometer was used which delivers a quick-released mechanical impulse exerting 0.40 N of pressure for 15 milliseconds. Two blinded examiners took myometer measurements on each tendon with the subject positioned in prone and the foot held in 0° of dorsiflexion. The myometer captured the following parameters for each tendon: state of tension, decrement, dynamic stiff-ness, creep and stress relaxation. A third examiner performed a weight-bearing lunge test and recorded the distance of the great toe from the wall for each tendon.RESULTS: Intraclass correlation coefficients (ICC) revealed short-term be-tween-examiner precision was excellent for tension (ICC2,1 = 0.94; 95% CI: 0.85, 0.97), good for stiffness (ICC2,1 = 0.88; 95% CI: 0.78, 0.93), and fair for decrement (ICC2,1 = 0.77; 95% CI: 0.61, 0.87), creep (ICC2,1 = 0.70; 95% CI: 0.46, 0.83) and stress relaxation (ICC2,1 = 0.63; 95% CI: 0.36, 0.78). Tension, stiffness and decrement were all negatively correlated with toe-to-wall distance during a weight-bearing lunge test (all, P<.05), re-spectively, explaining 7.0%, 10.9%, and 11.3% of the variance in the lunge test performance.CONCLUSIONS: MyotonPro measures of the Achilles tendon had fair-to-excellent short-term between-examiner precision, with the best preci-sion being for measures of tendon tension and stiffness. MyotonPro mea-sures of tension, stiffness and decrement were all negatively associated with Achilles tendon length on a functional lunge test suggesting that MyotonPro measures of the Achilles tendon provide indications of ten-don functional properties/length.CLINICAL RELEVANCE: The MyotonPro is a noninvasive device that has the potential to rapidly quantify soft tissue mechanical properties in a clini-cal setting.

OPO82THE IMPACT THAT MANAGERS’ PERSONAL FITNESS LEVELS AND THEIR PERCEIVED IMPORTANCE OF FITNESS IN THE WORKPLACE HAVE ON THE OVERALL FITNESS LEVELS OF PUBLIC EMPLOYEES WITH HIGHLY PHYSICAL JOBSDouglas Flint, Tyler Sedgwick, Nicole StephensIntermountain Healthcare, Ogden, UtahPURPOSE: The purpose of this study was to explore the correlation of man-ager’s perception of the importance of fitness and their own individual fit-ness levels have on the over all fitness levels of the employees they manage.DESCRIPTION: This study compared the fitness levels and perceived impor-

ing studied and include the use of controls to increase confidence lev-els in results.CLINICAL RELEVANCE: It is recommended that physical therapy interventions include neuromuscular training and re-education of core musculature to improve distal function, gait and balance. Regardless of the clinical set-ting, this may be the most efficient method to reach optimal functional performance. While many current treatment strategies focus on strength-ening that requires weeks and months, neuromuscular re-education of the transverse abdominis and surrounding core musculature yields similar re-sults but requires less physical resources, time and exertion by the patient.

OPO80DO ALTERED KINEMATICS AND KINETICS IN GAIT INCREASE PREVALENCE OF LOW BACK PAIN IN LOWER-LIMB AMPUTEES COMPARED TO ABLE-BODIED PEOPLE? A SYSTEMATIC REVIEWAmber Fleer, Andrew Brimhall, Bryson Jarman, Victoria Stack, Heather WhartonPhysical Therapy, Southwest Baptist University, Bolivar, MissouriPURPOSE/HYPOTHESIS: Low back pain (LBP) is a common cause of decreased function, lost workdays, and disability in the general population and one of the leading reasons patients seek physical therapy services. This sys-tematic review was designed to investigate the cause of the higher preva-lence of LBP in lower limb amputees (LLA) compared to able-bodied peo-ple. Specifically, we investigated if altered kinematics and kinetics in gait increases the prevalence of LBP in LLA compared to able-bodied people.NUMBER OF SUBJECTS: One hundred thirty-one.MATERIALS/METHODS: In April 2016 we searched Southwest Baptist University’s library database using keywords: low back pain, ampu-tation or amputee, and able-bodied people and found 15 598 articles. Limitations were added to bring the number of articles to 237: date from 2006 to 2016, peer reviewed articles, academic journals, and English lan-guage. These articles were screened by title and 225 records were exclud-ed due to relevance. The final 12 articles were assessed for inclusion of ki-netics or kinematics in gait as the cause of LBP in amputees. This left 4 studies to be included for data extraction and analysis.RESULTS: The 4 studies reviewed were all cross-sectional studies. All 4 studies were analyzed using the modified Downs and Black quality assess-ment tool. Using the modified Downs and Black assessment tool, 1 study was graded as good quality and 3 were graded as fair quality. Between the 4 studies evaluated, each had different hypotheses as for the cause of LBP in LLA. A majority of the studies found notable alterations during gait in LLA with LBP compared to able-bodied individuals or LLA with-out LBP. Gait alterations included differences in transverse, sagittal, or frontal plane motion, muscle activation, and forces applied through the lower extremities.CONCLUSIONS: Based on the quality and quantity of evidence evaluated in this review, we could not form a definitive conclusion to the cause of LBP in LLA. In addition, the studies failed to consider types of prostheses in their inclusion and exclusion criteria which could cause differences with-in the LLA group. Transverse plane motion was shown to be significant-ly different between LLA with LBP and both able-bodied individuals and LLA without LBP [8]. Another contributor to a higher prevalence in LBP in LLA includes increased spinal loads leading to coactivation and fatigue failure [6] of trunk musculature. Future research is needed to assess asym-metries between LLA with LBP and able-bodied individuals with LBP. In addition, research is needed to examine the differences in the prevalence and cause of LBP between transtibial and transfemoral amputees.CLINICAL RELEVANCE: While we cannot identify specific asymmetries as the cause of LBP in LLA, we can surmise that altered kinematics and kinet-ics may contribute to the higher prevalence of LBP in LLA based on the research. Clinicians must be aware of an increased risk of LBP in LLA and work to eliminate as many asymmetries as possible and increase core strength to counteract any residual asymmetries and abnormal spinal loads present.


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traction test are dependent on practitioners pulling with enough force to cause vertebral separation. This study demonstrated an effective training technique for proper performance of MCT. A 1-day training session that used motor learning principles and knowledge of results allowed physi-cal therapy students to perfect their MCT skills. The training produced the same percentage of participants that pulled within the correct range as previously reported for “master clinicians” (73%). Future research should investigate the effectiveness of utilizing biofeedback and motor learning principles to efficiently teach other manual therapy techniques.

OPO84PHYSICAL THERAPY REHABILITATION AFTER LONG-TERM CERVICAL IMMOBILIZATION FOLLOWING ATLAS (JEFFERSON) FRACTURE: A CASE REPORTCarla C. Franck, Judy Jicinsky, Alicia Emerson KavchakPhysical Therapy, UI Health, Chicago, Illinois; Performance Therapies, PC, Cedar Rapids, Iowa; Physical Therapy, High Point University, High Point, North CarolinaBACKGROUND AND PURPOSE: Fractures of the atlas (C1), though estimated to be as low as 3% of spinal injuries, have a reported mortality rate as high as 11.7%. Typical mechanism is axial loading at the top of the head with a resultant burst fracture, or Jefferson fracture, with or without upper cervical ligamentous rupture. Often there is no neurological involvement secondary to the width of the spinal canal at the level of C1. Medical man-agement of the dynamic instability requires cervical fusion and/or long-term immobilization. Common patient complaints following medical in-tervention include pain, stiffness, and limited cervical range of motion (ROM). Minimal evidence exists for rehabilitation following spinal stabi-lization after a Jefferson fracture. This case report describes the physical therapy (PT) interventions and outcomes of a patient after cervical immo-bilization following a Jefferson fracture.CASE DESCRIPTION: Patient was a 49-year-old woman who sustained a Jefferson fracture while in a motor vehicle accident where she rolled her car landing upside down. She was treated conservatively for 7 months in a halo vest with bone stimulator and subsequently with a rigid cervi-cal collar. Patient was referred to PT after the immobilization with ini-tial impairments of decreased cervical ROM, lack of cervical muscle flex-ibility and strength, cervicothoracic and rib joint hypomobility, impaired posture, reports of “muscular pain,” and functional limitations in driv-ing. Interventions included joint mobilizations targeting the lower cervi-cal spine and ribs and soft tissue mobilizations to the suboccipital region, scalene and trapezius muscles. Exercise progression included postur-al correction, deep neck flexor training, and upper extremity resistance training.OUTCOMES: The patient was seen for 25 PT sessions with interventions fo-cused on manual therapy and exercise. She demonstrated improvements in all her cervical active ROM: flexion from 0° to 10° to 0° to 50°, exten-sion 0° to 0° to 46°, right (R) rotation 0° to 25° to 0° to 60°, and left (L) rotation 0° to 18° to 0° to 55°. Her upper extremity strength improved to grossly 5/5 with manual muscle testing. Grip strength increased: (R) 40 to 54 lb, (L) 38 to 47 lb. Further, her average “muscular pain” on the nu-meric pain-rating scale improved from 4/10 to 0/10. She returned to all work and all daily activities without limitation. Patient returned to driv-ing with the soft collar per the physician’s instruction.DISCUSSION: Orthopaedic manual physical therapy (OMPT) treatment di-rected at the lower cervical spine/rib joints and soft tissue interventions, with follow-up therapeutic exercise, resulted in functional improvements after long-term cervical immobilization following a Jefferson fracture. While there is minimal evidence on the best PT treatment approach fol-lowing Jefferson fractures, clinical reasoning facilitated the direction and use of OMPT and therapeutic exercise.REFERENCES: 1. Delcourt T, Begue T, Saintyves G, Mebtouche N, Cottin P. Management of upper cervical spine fractures in elderly patients: Current trends and outcomes. Injury. 2015;46:S24-S27. 2. Longo UG,

tance of fitness of mangers to the overall fitness of the employees in each mangers department. A combination of job task specific fitness testing following the NFPA 1582 fitness guidelines and a survey of managers per-ceived importance of fitness was used to collect data.SUMMARY OF USE: This study reviewed the fitness testing results of 243 fire-fighters from 7 different city and county fire departments over a 4-year period and compared the overall fitness levels of each department’s fire fighters to the fitness level of the department’s Fire Chiefs and Deputy Chiefs and their perceived importance of fitness. This study found that there was a high correlation between the individual fitness level of the de-partment’s Fire Chiefs and Deputy Chiefs to the overall fitness level of the individual fire fighter in each department but a low correlation between the Fire Chiefs and Deputy Chiefs perceived importance of fitness and the overall fitness levels of the individual fire fighter in each department.IMPORTANCE TO MEMBERS: This study suggests that a key factor on the over-all fitness of public employees with highly physical jobs like fire fighters, is the fitness level of the department’s Fire Chief and Deputy Chief and not their perceived importance of fitness. This information can be useful in promoting health and wellness in the workplace by identifying the key role that department leaders play in promoting health and wellness to the individual employee by being fit themselves.

OPO83CERVICAL TRACTION TRAINING PROGRAM: UTILIZING BIOFEEDBACK AND MOTOR LEARNING PRINCIPLESEric Folkins, Thomas J. Buklarewicz, Lisa T. Hoglund, Yaroslav Sokoloversuskyy, Zachary Theinert, Francis RyanPhysical Therapy, University of the Sciences, Philadelphia, PennsylvaniaPURPOSE/HYPOTHESIS: Manual cervical traction (MCT) is a common inter-vention used by physical therapists to treat persons with neck pain and the cervical distraction test assists with the diagnosis of radiculopathy or zygapophyseal joint irritation by reducing the compression on irritat-ed structures. The therapeutic range of cervical traction is reported to be between 11.34 and 18.14 kg. A previous study demonstrated only 19% of novice clinicians and 73% of “master clinicians” (P<.01) produce the ap-propriate amount of force. The purpose of this study was to evaluate the effectiveness of a MCT training protocol using biofeedback and motor learning principles to improve students’ ability to apply the appropriate amount of force during MCT.NUMBER OF SUBJECTS: Seventeen recruited, 11 in the training portion.MATERIALS/METHODS: Third year doctor of physical therapy students from 1 university were recruited. Inclusion criteria included completion of one 8-week outpatient orthopaedic clinical experience and performance of MCT with patients. Participants completed MCT on a mannequin head/neck attached to the BTE Primus RS instrumented dynamometer. Participants who did not perform MCT within the recommended range of force, 11.34 to 18.14 kg, were enrolled in the training portion of the study. Training consisted of 3 phases of a faded auditory and visual feed-back protocol schedule. Participants were posttested 24 to 72 hours fol-lowing the training session. Average peak force of three 20-second trials was recorded.RESULTS: There was significantly more average force of pull posttest (17.44 kg) compared to pretest (9.68 kg) (P<.01). Five of 17 (29%) subjects pulled with the correct amount of force during pretesting and post testing results demonstrated 7/11 (72.7%) students pulled with the correct amount of force. There was a direct association between the training and the par-ticipant’s ability to pull within the appropriate range of force (P = .01).CONCLUSIONS: The present study demonstrated 29% of students pull with the correct amount of force during MCT. This is in close agreement from a previous study that reported 19% of students. One motor learning-bio-feedback training session was effective in teaching 72.7% of students MCT.CLINICAL RELEVANCE: Clinical practice guidelines recommend MCT as an in-tervention for persons with neck pain and valid results of the cervical dis-


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OPO86RELIABILITY OF MEASURES OF ANKLE-FOOT MORPHOLOGY, MOBILITY, AND STRENGTHJohn J. Fraser, Rachel Koldenhoven, Jay HertelKinesiology Department, Sports Medicine PhD Program, University of Virginia, Charlottesville, VirginiaPURPOSE/HYPOTHESIS: Lateral ankle and midfoot sprains result from high velocity moments and extremes of plantarflexion, adduction, and inver-sion [1-3]. Clinical assessment of foot posture, morphology, intersegmen-tal mobility, and strength of the ankle-foot complex following sprain is recommended for instruction in physical therapy education programs [4] and in practice [5]. The purpose was to determine test-retest reliability and interrater reliability of innovative and established clinical measures of morphology, joint excursion and accessory motion, and strength of the ankle-foot complex. We hypothesized reliability to be excellent for mor-phologic measures, fair to good for joint excursion and strength, and poor for joint accessory measures.NUMBER OF SUBJECTS: Data from 24 healthy, recreationally active individu-als aged 18 to 50 with no history of ankle or foot sprain or fracture were included (12 male, 12 female; mean ± SD age, 21.5 ± 4.8 years; BMI, 23.5 ± 2.9 kg/m2).MATERIALS/METHODS: Participants were assessed by 2 clinicians (a physical therapist with 14 years of experience and an athletic trainer with 2 years of experience) on 2 separate days. Order of clinician assessment was ran-domized using a Latin-square. Washout period between test sessions was 3 to 10 days. Foot posture and morphology was assessed using the Foot Posture Index and measures of foot length, width, truncated length and arch height. Joint mobility was assessed using goniometry (rearfoot and hallux excursion), inclinometry (forefoot), linear measures of sagittal ex-cursion (first ray and loaded rearfoot), and rating of joint accessory mo-tion. Strength was assessed using handheld dynamometry. Reliability was assessed with intraclass coefficients (ICC model 2,k), with greater than 0.75 interpreted as being excellent, 0.40 to 0.75 as fair to good, and less than 0.40 as poor [7].RESULTS: Test-retest reliability was excellent in all foot posture and mor-phologic measures (0.80-1.00), talocrural (0.81-0.97) and hallux (0.82-0.95) joint excursion measures, fair to excellent for first ray sagittal ex-cursion (0.62-0.90) and frontal plane rearfoot (0.58-0.73) and forefoot (0.72-0.86) excursion, and strength (0.67-0.92) measures. Intertester re-liability of joint accessory motion (–0.67 to 0.84) varied on clinical expe-rience, with the more experienced clinician demonstrating greater consis-tency (67% of measures greater than 0.40) compared the novice clinician (36% of measures greater than 0.40). Interrater reliability was excellent in morphologic measures (0.81-1.00) and talocrural (0.76-0.97) and hal-lux (0.85-0.91) excursion measures, fair to excellent in forefoot (0.66-0.86) excursion and strength measures (0.53-0.90), fair to good in rear-foot frontal plane excursion (0.53-0.69), poor to good in hallux excursion (0.32-0.53), and poor (–1.06 to 0.39) in 73% of joint accessory measures.CONCLUSIONS: Measures of ankle-foot posture, morphology, joint excur-sion, and strength demonstrated fair to excellent test-retest and interrater reliability. Joint accessory measures had poor to fair agreement overall.CLINICAL RELEVANCE: These findings should be considered when selecting ankle-foot assessment measures.

OPO87THE INFLUENCE OF TENSION AND SLIDING TECHNIQUES ON NEURODYNAMIC DYSFUNCTION IN THE CONTRALATERAL EXTREMITYRobert J. Friberg, Stephanie ThurmondDepartment of Physical Therapy, Hardin-Simmons University, Abilene, Texas; Physical Therapy, University of the Incarnate Word, San Antonio, TexasPURPOSE/HYPOTHESIS: To determine if neural tissue management, via slid-ing or tensioning of the least neurodynamically involved upper extremity

Denaro L, Campi S, Maffulli N, Denaro V. Upper cervical spine injuries: Indications and limits of the conservative management in halo vest. A sys-tematic review of efficacy and safety. Injury. 2010;41:1127-1135. 3. Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Hoving JL. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15:334-354. 4. Mitchell RJ, Stanford R, McVeigh C, Bell D, Close JC. Incidence, circumstances, treatment and outcome of high-lev-el cervical spinal fracture without associated spinal cord injury in new south wales, Australia over a 12 year period. Injury. 2014;45:217-222. 5. Babak Kalantar S. Fractures of the C1 and C2 vertebrae. Semin Spine Surg. 2013;25:23-35.

OPO85RELIABILITY OF ULTRASOUND MEASURES OF INTRINSIC FOOT MOTOR FUNCTIONJohn J. Fraser, Jay HertelKinesiology Department, Sports Medicine PhD Program, University of Virginia, Charlottesville, VirginiaPURPOSE/HYPOTHESIS: The intrinsic foot muscles (IFM) play an important role in the shaping of the foot [1,2], force attenuation [1,3], and force transmission [1,3] during propulsion. Currently, clinically accessible as-sessment of IFM function and size has been limited to the IFM test [4] and resting ultrasound (US) imaging measures [5]. Reliability has yet to be established for innovative measures of IFM function under US im-aging during dynamic activity. The purpose of this study was to estab-lish test-retest reliability of US measures of IFM size and motor function.NUMBER OF SUBJECTS: Data from 24 healthy, recreationally active individ-uals ages 18 to 50 with no history of ankle or foot sprain or fracture were included (12 male, 12 female; mean ± SD age, 21.5 ± 4.8 years; BMI, 23.5 ± 2.9 kg/m2).MATERIALS/METHODS: Participants were imaged on 2 separate days by a physical therapist with 14 years of clinical experience and 2 months of experience using US imaging. Washout period between test sessions was 3 to 10 days. US cross section area (CSA, cm2) and thickness (cm) of the right (RT) and left (LT) abductor hallucis (AbdH), flexor digitorum bre-vis (FDB), quadratus plantae (QP), and flexor hallucis brevis (FHB) were measured at rest and during active contraction, while resisted, and while performing toe spread, isolated hallux extension, and lesser toe extension exercises. Contracted measures were normalized to resting values and re-ported as activation ratios. Reliability was assessed with intraclass coeffi-cients (ICC model 2,k), with greater than 0.75 interpreted as being excel-lent, 0.40 to 0.75 as fair to good, and less than 0.40 as poor [6].RESULTS: Reliability of resting US measures of AbdH CSA (Baseline RT, 2.66 ± 0.64 cm2; LT, 2.63 ± 0.57 cm2; Final RT, 2.66 ± 0.60 cm2; LT, 2.67 ± 0.54 cm2; ICC = 0.97-0.98) and thickness (Baseline RT, 1.25 ± 0.20 cm; LT, 1.26 ± 0.19 cm; Final RT, 1.28 ± 0.21 cm; LT, 1.25 ± 0.21 cm; ICC = 0.88-0.91), FDB CSA (Baseline RT, 1.87 ± 0.52 cm2; LT, 1.81 ± 0.44 cm2; Final RT, 1.77 ± 0.46 cm2; LT, 1.80 ± 0.42 cm2; ICC = 0.93-0.91) and thickness (Baseline RT, 0.84 ± 0.19 cm; LT, 0.80 ± 0.15 cm; Final RT, 0.81 ± 0.16 cm; LT, 0.76 ± 0.14 cm; ICC = 0.87-0.89), QP CSA (Baseline RT, 1.47 ± 0.59 cm2; LT, 1.40 ± 0.51 cm2; Final RT, 1.47 ± 0.61 cm2; LT, 1.47 ± 0.58 cm2; ICC = 0.97-0.98) and thickness (Baseline RT, 0.91 ± 0.18 cm; LT, 0.91 ± 0.15 cm; Final RT, 0.90 ± 0.17 cm; LT, 0.94 ± 0.18 cm; ICC = 0.90-0.92), and FHB CSA (Baseline RT, 3.00 ± 0.69 cm2; LT, 2.99 ± 0.85 cm2; Final RT, 2.97 ± 0.68 cm2; LT, 2.97 ± 0.83 cm2; ICC = 0.95-0.98) and thickness (Baseline RT, 1.42 ± 0.22 cm; LT, 1.38 ± 0.18 cm; Final RT, 1.38 ± 0.19 cm; LT, 1.38 ± 0.19 cm; ICC = 0.76-0.83) were excellent. During function, reliability of active, resisted and toe exercise CSA measures was excellent (ICC = 0.81-0.99) and good to excellent (ICC = 0.66-0.93) for thickness measures.CONCLUSIONS: US measures of IFM function were found to have good to excellent reliability.CLINICAL RELEVANCE: These measures may have utility in patient care and clinical research and should be considered as a potential outcome measure.


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minimal clinically important difference (MCID), and the association with the SE score at intake was determined.RESULTS: The results of this study show no significant effect for SE levels and any of the physical therapy outcome measures as evident by the sta-tistically high power values. Point biserial correlation revealed that self efficacy at intake was not associated with meeting the MCID in either the specified outcome measures, r = 0.175, P = .606 or the pain scale, r = 0.589, P = .296. Relative to other reports, the average SE score was par-ticularly high at 81% ± 0.12%.CONCLUSIONS: The lack of association between SE at intake and clinical outcome might indicate a true disassociation of the variables or unique circumstances in this study. As subjects were treated by student physical therapists under the supervision of clinical instructors, it is possible that patients seeking treatment in this setting might represent a unique sub-set of the population with higher SE levels on average. This could explain the lack of SE variability in the data collected.CLINICAL RELEVANCE: The particularly high SE scores obtained in this study might indicate a need for larger sampling and expansion of the psycho-social parameters measured. Additionally, clinical researchers collecting data in an educational setting should consider if generalizability is limit-ed by the unique characteristics of patients seeking care in that setting.

OPO89EXAMINATION OF ACROMIOHUMERAL DISTANCE IN UPRIGHT AND SELF-SELECTED SEATED POSTURES USING REAL-TIME ULTRASOUND IMAGING IN NORMAL HEALTHY SUBJECTSCynthia H. Gill, Caitlin Murray, Tamar Sivaslian, Brian Lloyd, Bo MurphyPhysical Therapy, University of Maryland Eastern Shore, Princess Anne, MarylandPURPOSE/HYPOTHESIS: The subacromial space, a common site of shoulder impingement, pain, and dysfunction can be assessed by measuring the acromiohumeral distance (AHD). A decrease in the AHD can lead to an increase in the risk of impingement, which can lead to pain and disabili-ty. Postural changes have been theorized to impact AHD. The purpose of this study was to examine the relationship between AHD and varying de-grees of shoulder abduction in self-selected (SSP) and standardized up-right seated posture (USP) using Real-Time Ultrasound (RTUS).NUMBER OF SUBJECTS: Thirty-four normal subjects (mean age, 25 years; 22 male, 12 female).MATERIALS/METHODS: Anthropometric measurements were obtained and maximal grip strength was assessed. Subjects were screened for scapular stability and impingement using standardized clinical tests. Ultrasound images of AHD were captured with the arm at rest and at 30°, 45°, and 60° abduction with the subject in SSP and in USP. The AHD was deter-mined to be the linear distance between the “last” visible point of the hu-merus and the highest point of the acromion process. Intraexaminer reli-ability between sessions using 10 subjects was measured and resulted in ICC values ranging from 0.85 (CI: 0.41, 0.96) to 0.95 (CI: 0.82, 0.99) for SSP and 0.92 (CI: 0.68, 0.98) to 0.97 (CI: 0.89, 0.99) for USP. All analy-ses were performed with SPSS Version 21.RESULTS: Statistical analysis showed no significant differences in AHD be-tween SSP and USP positions. Within SSP, AHD at rest (1.31 ± 0.20 cm) was significantly larger than 30° (1.18 ± 0.25 cm), 45° (1.02 ± 0.22 cm), and 60° (1.03 ± 0.20 cm) abduction and AHD at 30° abduction was sig-nificantly larger than 45° and 60°. Within USP, AHD at rest (1.30 ± 0.19 cm) was significantly larger than 30° (1.21 ± 0.24 cm), 45° (0.99 ± 0.23 cm), and 60° (1.01 ± 0.19 cm) abduction and AHD at 30° abduction was significantly larger than 45° and 60° abduction. No significant differenc-es in AHD were found between 45° and 60°abduction within either SSP or USP.CONCLUSIONS: These results provide evidence suggesting that posture may not have a significant effect on AHD and therefore may not be a primary cause of subacromial impingement. AHD appears to be largest at rest (0°

influences function of the contralateral extremity in individuals with me-dian or ulnar nerve dysfunctionNUMBER OF SUBJECTS: Forty-two college students (15 male, 27 female) who demonstrated a positive Upper Limb Neural Tension Test (ULNTT) for either the median or ulnar nerve.MATERIALS/METHODS: Subjects completed an informed consent, demo-graphic information sheet, Neck Disability Index (NDI), and Disabilities of the Shoulder and Hand Questionnaire (QuickDASH) prior to screen-ing before being randomly assigned to either a tensioning (n = 11), sliding (n = 9), combination of tensioning and sliding (n = 11), or control (n = 11) group for treatment. Outcome measures included cervical range of mo-tion (ROM), grip and pinch strength, and upper limb tension test (ULTT) of the median (extension range of motion at the elbow) and ulnar (ab-duction range of motion at the shoulder) nerves. Tensioning, sliding, and combination groups received a home exercise program (HEP) to perform 2 minutes per day for 2 weeks. Tensioning is defined as a technique to in-crease tension in neural structures by stabilizing the nerve at 1 point and elongating at another point. Sliding is defined as an technique to produce sliding of neural structures relative to their adjacent tissues. Sliding is produced by elongating the nerve at 1 joint and shortening at another to create the sliding motion. The control group was advised to continue their usual activities. ULTT restrictions were assessed goniometrically during elbow extension (for median nerve) and shoulder abduction (for ulnar nerve) at the point in the ROM where symptoms were provoked. Grip and pinch strength were assessed using a handheld dynamometer (setting 2). The mean of 3 successive trials was used for analysis.RESULTS: No statistically significant differences were found among treat-ment groups on any outcome variable prior to the intervention. No sta-tistically significant changes in any outcome measures were found in the contralateral arm (P>.05), although positive trends were observed in me-dian and ulnar ROM in the tensioning group.CONCLUSIONS: Neurodynamic treatment of the opposite extremity did not produce a significant change in the neurodynamic function as measured by range of motion and strength of the contralateral limb.CLINICAL RELEVANCE: Neurodynamic treatment through tensioning, sliding, or a combination of both using the opposite extremity is not effective. The extremity with median or ulnar neurodynamic dysfunction is where treat-ment should be directed.

OPO88DOES PATIENT SELF-EFFICACY AT INTAKE PREDICT THE THERAPEUTIC OUTCOME?Molly J. Geiger, Stephanie Juhnke, Ellen Maloney, Danny J. McMillianPhysical Therapy, University of Puget Sound, Tacoma, WashingtonPURPOSE/HYPOTHESIS: While the biopsychosocial model has become in-creasingly understood and accepted amongst physical therapists, identi-fying all psychological factors relating to physical therapy seems unrealis-tic due to limited time and resources. While depression, catastrophizing, and fear-avoidance have been the main focus of current research looking at psychosocial risk factors, Foster has shown self-efficacy to be a more important factor in determining patient outcomes in a primary care set-ting. Therefore, the purpose of this study was to explore the relationship between patient self-efficacy (SE) levels at intake and physical therapy outcomes. We hypothesized that higher SE scores would be associated with more successful outcomes upon conclusion of the episode of care.NUMBER OF SUBJECTS: Seventeen.MATERIALS/METHODS: Subjects from the University of Puget Sound’s out-patient musculoskeletal clinic were included in the study. Prior to their initial PT evaluation, subjects completed the General Self Efficacy Questionnaire, a relevant outcome measure given their presenting con-dition, and the numeric pain-rating scale (NPRS). The relevant outcome measure and NPRS were repeated at the conclusion of the episode of care. Changes in outcomes measures and NPRS were compared against the


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OPO91DIFFERENTIAL DIAGNOSIS FOR ANTERIOR KNEE PAIN UTILIZING MECHANICAL DIAGNOSIS AND THERAPYGerard GordonCenter for Musculoskeletal Care, NYU Langone Medical Center, East Rockaway, New YorkBACKGROUND AND PURPOSE: Research shows that determining a pathoana-tomical diagnosis for non–red flag musculoskeletal conditions is challeng-ing. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has been found to be a valid and reliable assessment approach for the spine and is undergoing initial trials in the extremities. MDT attempts to classify patients into distinct subgroups based on a thorough history and symptomatic and mechanical response to different loading strategies. The treatment is tailored to the patient based on the classification. This case highlights the utility of MDT to differentially diagnose between 2 classifi-cations and provide an effective treatment.CASE DESCRIPTION: The patient was a 20-year-old man who presented with a diagnosis of bilateral patellar tendonitis. He reported an onset of bi-lateral anterior knee pain which began 3 years ago when he landed hard while playing basketball. He felt as though the condition was worsen-ing because he could no longer play basketball or squat. Additional ag-gravating factors included prolonged sitting and ascending stairs. At the completion of the history a provisional MDT classification of contractile dysfunction and derangement were possible. Contractile dysfunction is considered to be structurally compromised contractile soft tissue which is analogous to chronic tendinopathy. The hallmark of dysfunction is con-sistency of pain which is only produced when the dysfunctional tissue is sufficiently loaded. Derangement is the clinical presentation associated with a mechanical obstruction of an affected joint. Directional preference is an essential feature and variability is the hallmark symptom behavior. The physical exam that followed was structured to help differentiate be-tween the 2. Primary concordant baselines included end range pain with passive knee flexion, end range pain and obstruction of passive knee ex-tension, patellar tendon tenderness to palpation, pain and weakness with knee extension manual muscle testing, pain with ascending stairs, and painful squat limited to 90°. Screen of the lumbar spine was negative. Repeated end-range patient-generated knee extension techniques pro-duced clinically significant changes in all concordant baselines. Due to rapid change of baselines in response to a specific directional preference, provisional classification of derangement was made. The patient was seen for 4 sessions over the course of 6 weeks. During this time all baselines were normalized.OUTCOMES: Initial LEFS: 35/80. The patient was contacted 2 weeks af-ter his final appointment. He reported having played in basketball tour-nament without limitations and that he continues to use his specific di-rectional preference exercise to keep the knees feeling good. Final LEFS: 80/80.DISCUSSION: This case demonstrates the importance of classification to help guide treatment. Thoughtful mechanical testing allows the clinician to understand the true nature of a condition. In this case, classification of derangement led to rapid resolution of a chronic worsening condition.REFERENCES: Crossley KM, Callaghan MJ, Linschoten R. Patellofemoral pain. Br J Sports Med. 2016;50:247-250. Hegedus EJ, et al. Physical ex-amination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2007;37:541-550. Lynch G, May S. Directional preference at the knee: a case report using mechanical diagnosis and therapy. J Man Manip Ther. 2013;21:60-66. May S, Rosedale R. A survey of the McKenzie classification system in the extremities: prevalence of mechanical syndromes and preferred loading strategies. Phys Ther. 2012;92:1175-1186. May S, Ross J. The McKenzie classification system in the extremities: a reliability study using McKenzie assessment forms and experienced clinicians. J Manipulative Physiol Ther. 2009;32:556-563. McKenzie R, May S. The Human Extremities.

abduction) and smallest at 45° abduction. However, due to the limitation of measuring abduction past 45° with RTUS, future research is needed to confirm these results.CLINICAL RELEVANCE: The practice of RTUS allows PTs to observe neuro-muscular structures in real time and during various physiological move-ments. Through our background and clinical knowledge, posture can have an effect on impingement syndrome in the GH joint. By observing this in the clinic, PTs can note the PTs posture in the examination process and use the RTUS to observe any SAS narrowing that could be contribut-ing to the impingement. Our data suggest that posture may have a small to minimal effect on subacromial space and shoulder impingement, but given our limitations, more research is needed to further investigate the effects of posture on AHD.

OPO90TALAR DOME ARTICULAR CARTILAGE THICKNESS IN INDIVIDUALS WITH AND WITHOUT ANKLE SPRAINSMegan M. Gill, John Kipp, Gary S. ChlebounDivision of Physical Therapy, Ohio University, Athens, OhioPURPOSE/HYPOTHESIS: Continuous joint stresses due to joint instability can degrade the articular cartilage, decrease articular cartilage thickness, and potentially lead to osteoarthritis. While much attention has been direct-ed toward the use of ultrasound imaging to determine femoral condyle articular cartilage thickness in patients with knee instability, relatively few studies have addressed talar dome articular cartilage thickness in pa-tients with ankle instability. The purpose of this study was to determine if a single ankle sprain or multiple ankle sprains results in changes in the thickness of the talar dome articular cartilage as measured by ultrasound (US) imaging.NUMBER OF SUBJECTS: Seventeen.MATERIALS/METHODS: Subjects were assigned to 1 of 3 groups: control (no ankle sprains, n = 6; 22.0 ± 1.1 years), coper (single ankle sprain, no self-reported episodes of instability, n = 5; 22.8 ± 1.3 years), and chronic in-stability (multiple ankle sprains with episodes of instability, n = 6; 24.5 ± 2.2 years). Subjects with ankle sprains were included only if the most recent sprain was at least 2 months prior to participation in the study. Longitudinal US images of the talar dome were recorded on the lateral, middle, and medial aspects of the talar dome with the subject’s ankle in full plantarflexion. The articular cartilage thickness was measured per-pendicular to the subchondral bone at 3 points (both ends and the middle of the visible image of the dome of the talus) using ImageJ (a Java-based version of the public domain NIH Image Software). The average of the 3 measurements was calculated for each location (lateral, middle, and me-dial) of the talar dome.RESULTS: The results suggest that there was a difference (P≤.05) in talar dome articular cartilage thickness between the medial (0.88 ± 0.31 mm) and middle (0.72 ± 0.22 mm) locations of the talar dome. The main effect of group was not significant (P = .235); however, there was a trend sug-gesting that the subjects with multiple ankle sprains had increased talar dome thickness compared to control subjects. The location by group in-teraction was also not significant (P = .268).CONCLUSIONS: Preliminary results show that the thickness of the talar dome articular cartilage may vary slightly between the medial and middle aspects of the talar dome. A history of a single or multiple ankle sprains does not appear to have an effect on the thickness of the talar dome artic-ular cartilage thickness in college age subjects.CLINICAL RELEVANCE: Joint instability is thought to be a precipitating fac-tor in the development of osteoarthritis. As a consequence of osteoarthri-tis, the articular cartilage becomes thinner. These results suggest that in young subjects, single or multiple ankle sprains do not have an effect on talar dome articular cartilage thickness. Although some changes in ar-ticular cartilage collagen fiber integrity have been seen in young subjects with chronic ankle instability, thickness does not appear to change.


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OPO93NORMAL SENSORY RESPONSE AND DISTRIBUTION OF THE STRAIGHT LEG RAISE TEST ON ASYMPTOMATIC INDIVIDUALSMark Gugliotti, Peter C. Douris, Yiyu Lin, Anika Paul, Alessandro L. Asaro, Jillian Epifania, Robert Garrick, Brian Mathew, Gleb KartsevNew York Institute of Technology, Wading River, New YorkPURPOSE/HYPOTHESIS: The straight leg raise (SLR) is a passive test com-monly used to assess neurodynamic response to movement. To date, there is a lack of research describing the quality, quantity, and distribution of normal sensory response associated with the SLR test. The purpose of our study was to examine the normal sensory response and distribution of the SLR test on asymptomatic individuals. We hypothesized that: (1) the sensory response would be along the sciatic nerve distribution and its distal tributaries, (2) no significant difference in sensory response would exist between limbs.NUMBER OF SUBJECTS: Forty-seven.MATERIALS/METHODS: This was a cross-sectional study. The range of mo-tion, quality, quantity, and distribution of sensory responses were mea-sured in 47 asymptomatic individuals during the SLR test. Passive an-kle dorsiflexion and passive neck flexion were used as neural sensitizing maneuvers.RESULTS: The total means ± SD of sensory responses for the left and right lower extremities were respectively as follows: stretching was 6.25 ± 1.75 and 6.63 ± 2.09 cm; burning was 4.28 ± 3.07 and 6.70 ± 5.39 cm; tin-gling was 2.65 ± 3.06 and 2.63 ± 3.05 cm; and numbness was 2.80 ± 0.14 and 0.60 ± 0.14 cm. The sensation of stretch was the most prominent response (96%) of those experienced. The distribution and frequency of sensory response for the left and right lower extremities were respective-ly as follows: posterior thigh was 74% and 74%; posterior knee was 26% and 32%; posterior calf was 21% and 34%; and plantar foot surface 2% and 4%. The frequency at which passive ankle dorsiflexion increased the local sensory response intensity was 98% for the left lower extremity and 89% for the right lower extremity. Finally, the frequency at which passive neck flexion increased the local sensory response intensity was 11% for both lower extremities.CONCLUSIONS: The results of this study provide evidence that there are no significant differences in sensory response between limbs during the SLR test in asymptomatic individuals. Sensory responses were along the sci-atic nerve distribution and its distal tributaries. The results also suggest passive ankle dorsiflexion acts as an effective neural sensitizing maneuver when performing the SLR test.CLINICAL RELEVANCE: The clinical implications of these findings suggest that therapists should expect sensory responses during SLR testing to follow along the sciatic nerve distribution and to confirm the suspicion of nerve tissue involvement with passive ankle dorsiflexion.

OPO94CLINICAL DECISION MAKING WITH AN UNDIAGNOSED POSTTRAUMATIC TYPE I FRACTURE OF THE RADIAL NECKDesarae N. Gutierrez, Anthony Cheung, Daniel Cricchio, Trisha PerryNova Medical Centers, Houston, TexasBACKGROUND AND PURPOSE: Posttraumatic type I fractures of the radial neck should be considered as potential acute injuries of the arm with an aging and labor intensive workforce. A physical therapist’s (PT) knowledge of an abnormal patient presentation in addition to the use of evidence-based tools is beneficial towards the clinical decision making of musculoskele-tal-related injuries.CASE DESCRIPTION: A 60-year-old female housekeeper experienced height-ened pain in her right elbow after catching her left foot in a bed skirt and suffering a fall onto her right elbow. Initial X-rays (3 views) that were taken the day after her injury were found negative for fracture and/or

Raumati Beach, New Zealand: Spinal Publications New Zealand Ltd; 2000. Rosedale R, et al. Efficacy of exercise intervention as determined by the McKenzie system of mechanical diagnosis and therapy for knee osteoarthritis: a randomized controlled trial. J Orthop Sports Phys Ther. 2014;44:173-181. Smith BE, Hendrick P, Logan P. Patellofemoral pain: challenging current practice—a case report. Man Ther. 2015. Smith BE, et al. Patellofemoral pain: is it time for a rethink? McKenzie Institute Mechanical Diagnosis and Therapy Practitioners (MIMDTP) UK Newsletter; 2015.

OPO92RELIABILITY OF HIP ROTATION RANGE OF MOTION IN SUPINE AND SEATED POSITIONSMarissa Gradoz, Lauren Bauer, Terry L. Grindstaff, Jennifer J. BagwellCreighton University, Omaha, NebraskaPURPOSE/HYPOTHESIS: Hip rotation range of motion (ROM) is a common-ly assessed in individuals with hip pathology. While supine and seated hip rotation range of motion testing positions are both common, it re-mains unknown which testing position has optimal reliability. Therefore, the purpose of this study was to compare inter and intrarater reliability between hip internal and external rotation in the supine and seated posi-tions in experienced and novice practitioners.NUMBER OF SUBJECTS: Nineteen participants without hip, knee, or lumbar spine pain (11 female, 8 male; mean ± SD age, 23.5 ± 1.2 years).MATERIALS/METHODS: Three testers (one with 10 years of orthopaedic phys-ical therapy experience and 2 first year physical therapy students) per-formed 2 testing sessions (3-7 days between sessions). Passive external and internal rotation ROM was measured using a standard goniometer. Measures were obtained on both right and left limbs in 2 positions: su-pine and seated (hip and knee in 90° of flexion). Interrater and intrarater reliability were calculated in SPSS using interclass correlation coefficients (ICC). Minimal detectable change (MDC) was also calculated (standard error of the measure × 1.96 × √2).RESULTS: Interrater reliability for supine hip external and internal rota-tion ROM were good to excellent (ICC = 0.62-0.87 [right and left] and 0.70-0.88, respectively). Between session intrarater reliability for supine hip external and internal rotation ROM was excellent for all raters (ICC = 0.77-0.96). Interrater reliability was fair to excellent for seated hip exter-nal rotation ROM (ICC = 0.52-0.79) and was good for seated hip internal rotation ROM (ICC = 0.60-0.68). In the seated position, intrarater reli-ability for hip external rotation ROM was excellent for the experienced clinician (ICC = 0.81-0.83) and fair to excellent for the novice clinicians (ICC = 0.52-0.94). Seated hip internal rotation ROM intrarater reliabil-ity was good to excellent for the experienced clinician (ICC = 0.61-0.77) and was fair to excellent for the novice clinicians (ICC = 0.59-0.82). MDC values among the 3 testers were as follows: supine hip external rotation ROM, 4.5°-10.5°; supine hip internal rotation ROM, 4.5°-11.3°; seated hip external rotation ROM, 4.2°-8.0°; and seated hip internal rotation ROM, 5.6°-11.5°.CONCLUSIONS: Overall, both seated and supine hip rotation ROM measures had fair to excellent reliability between and within testers. However, hip rotation measured in supine had slightly higher inter and intrarater val-ues, particularly for the novice clinicians. The MDC values did not vary substantially between seated and supine hip rotation ROM.CLINICAL RELEVANCE: This study demonstrated reliability and MDC val-ues of supine and seated hip rotation ROM testing for experienced and novice clinicians. This is important clinically because hip rotation ROM is a common measurement used to evaluate persons with hip patholo-gy. Furthermore, this study suggests that the supine testing position may be more reliable than the seated position and may be the optimal choice, particularly for novice clinicians.


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purpose of this study was to evaluate the interrater reliability of frontal plane knee valgus motion during the landing phase of a single limb hop in asymptomatic participants using the iPad application SparkMotion (SparkMotion, LLC).NUMBER OF SUBJECTS: Thirty asymptomatic adult participants, 14 male and 16 female.MATERIALS/METHODS: Participants meeting inclusion criteria completed a demographic questionnaire reporting their age, height, body mass, and dominant leg. Two investigators independently observed a video of a sub-ject performing the single-leg hop test with a standardized landing point in real time and estimated the degree of knee valgus at the terminal point where eccentric momentum ended. Then, investigators watched the vid-eo again using the software to pause the video at the terminal point and measured the amount of knee valgus with a virtual goniometer tool. Each of the 30 subjects performed the test 3 times on each leg for a total of 6 jumps. The reliability was evaluated by the intraclass correlation coeffi-cient (ICC) model 3,k for the intrarater component of analysis and mod-el 2,k for the interrater analysis. Model 2,k was used to determine if the SparkMotion can be used with confidence and reliability among equally trained clinicians.RESULTS: ICCs for visual estimate of dominant leg were 0.90; ICC for vi-sual estimate of nondominant leg was 0.87; ICC SparkMotion dominant leg was 0.95; ICC SparkMotion non dominant leg = 0.91. The concurrent validity between visual and SparkMotion had an ICC value of 0.91 for rat-er A and 0.86 for rater B.CONCLUSIONS: The results show higher interrater reliability with the use of the SparkMotion application compared to visual estimate alone; however, the visual estimates still showed moderate to high reliability with ICC val-ues. To our knowledge, this is the only study to evaluate the single-leg hop test utilizing a 2-D application. Results may not be generalized to symp-tomatic cohorts; however, the utility of these findings support reliability for potential screenings purposes.CLINICAL RELEVANCE: The results of our study support the use of real-time video observation as a reliable measurement of frontal plane knee kine-matics; however, video-based measurements utilizing an app that can slow movement and measure angels via a virtual goniometer offer greater reliability. Moreover, real-time visual estimation of video may offer com-parable correlation and agreement to analysis utilizing specific movement analysis applications (eg, video goniometric).

OPO96ARTHROSCOPIC PARTIAL MENISCECTOMY VERSUS CONSERVATIVE TREATMENT FOR THE DEGENERATIVE MENISCUS: A SYSTEMATIC REVIEWRichard Haydt, Kyle D. Freeman, Zach Bottone, Jomar Farrales, Jared E. HuntPhysical Therapy, Misericordia University, Dallas, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose of this systematic review was to ex-amine available evidence regarding arthroscopic partial meniscectomy (APM) and conservative therapy for the treatment of the degenerative meniscus. Practitioners may be uncertain of the best intervention upon which to treat patients with this musculoskeletal disorder. Current liter-ature provides research on conservative therapies and surgical interven-tion, but a review of this research is needed to establish which interven-tion is cost effective and has the best patient outcomes.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: Data sources, including MEDLINE, CINAHL, PubMed, EBSCO, and PEDro, were used to conduct the literature review. Inclusion criteria was comprised of degenerative meniscal tears, chron-ic knee pain affecting function, 35- to 80-year-old subjects, and MRI-verified meniscal tears. Exclusion criteria was comprised of traumatic meniscal tears, additional ACL rupture with the meniscal tear, prior knee surgery, and OA graded 3, 4 on the Kellgren-Lawrence classification scale. The average level of evidence was found to be a level II and the average PEDro score was a 6.6/10. Keywords included physical therapy, degener-

dislocation. A small bone spur off the olecranon was found leading the physician to order an X-ray overread. X-ray overread was also found to be negative for fracture and/or dislocation. Upon initial physical therapy evaluation, the patient reported a pulling type pain at the right elbow dur-ing elbow extension. Patient presented with moderate swelling and was without visible bruising. Tenderness to palpation was present over the olecranon, posterior fat pad, the cubital fossa with minimal depth pal-pation, and throughout the forearm and wrist. Right elbow range of mo-tion, both active and passive, was decreased in flexion and greatly limit-ed into extension. Extension was met with an abrupt stop passively with a hard end feel and heightened pain. Grip strength findings were reduced 50% compared to the uninvolved side, although manual muscle testing of the involved elbow was minimally decreased with flexion and extension.OUTCOMES: Upon initial evaluation, positive objective findings and symp-toms suggested a radial neck fracture. PT proceeded to review X-ray im-ages with the physician for a possible fat pad sign/sail sign and abnormal joint spacing to further support objective findings. X-rays appeared to be negative for a fat pad sign/sail sign but showed decreased joint spacing of the humeroradial joint. Due to increased patient complaints of wrist pain, repeat X-rays were completed in addition to advanced imaging being or-dered to rule out a radial neck fracture. Both repeat X-rays and CT scan results returned negative findings. Patient continued to present with de-creased elbow extension with a hard end feel and pain. PT, secondary to ongoing patient complaints and objective findings of positive elbow ex-tension test 1, tuning fork [3,4] and ultrasound [2,5], indicating a pos-sible fracture, recommended further imaging to the referring physician. MRI results revealed a type I fracture of the radial neck.DISCUSSION: Patient presentation along with strong clinical reasoning skills based on current evidence-based literature can assist PTs in the differential diagnosis of adverse events that have yet to be substantiat-ed with advanced imaging. PTs can contribute to the efficiency of diag-nostic imaging pathways by collaborating with physicians in the differen-tial diagnosis of potentially undiagnosed fractures and avoid unnecessary interventions.REFERENCES: 1. Appelboam A, Reuben AD, Benger JR, et al. Elbow exten-sion test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008;337:a2428. 2. Beck B. Can therapeutic ultrasound accurate-ly detect bone stress injuries in athletes? Clin J Sport Med. 2013;23:241-242. 3. Moore, MB. The use of a tuning fork and stethoscope to identi-fy fractures. J Athl Train. 2009;44:272-274. 4. Mugunthan K, Doust J, Kurz B, Glasziou P. Is there sufficient evidence for tuning fork tests in di-agnosing fractures? A systematic review. BMJ Open. 2014;4:e005238. 5. Papalada A, Malliaropoulos N, Tsitas K, Kiritsi O, Padhiar N, Del Buono A, et al. Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes. Am J Sports Med. 2012;40:915-919.

OPO95THE RELIABILITY OF MEASUREMENTS USED TO QUANTIFY FRONTAL PLANE KNEE KINEMATICS DURING A SINGLE-LEG HOP TEST: A VIDEO ANALYSISWilliam J. Hanney, Morey J. Kolber, Michelle M. Ramirez, Rodney Negrete, Kathleen Palmer, Scott W. Cheatham, Patrick Pabian, Xinliang LiuHealth Professions, University of Central Florida, Orlando, Florida; Sports Medicine and Rehabilitation, Florida Hospital, Orlando, Florida; Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida; California State University Dominguez Hills, Carson, CaliforniaPURPOSE/HYPOTHESIS: It has been reported that functional landing valgus during the single-leg hop may be associated with lower extremity dys-function and risk based assessments are often inclusive of this test. Video analysis may be a tool used by clinicians to identify abnormal move-ment patterns that might be elusive to standard observation. Thus, the


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itis: revision 2014 clinical practice guidelines. J Orthop Sports Phys Ther. 2014;44;1-23. 2. Cotchett MP, Landorf KB, Munteanu SE, Raspovic A. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Am J Phys Ther. 2014:94;1083-1095. 3. Dommerholt J, Hooks T, Finnegan M, Grieve R. A critical overview of the current myofascial pain literature-March 2016. J Bodyw Mov Ther. 2016;20:397-408. 4. Rodríguez-Mansilla J, Gonzàlez-Sànchez B, De Toro García À, Valera-Donoso E, Garrido-Ardila EM, Jiménez-Palomares M, Gonzàlez López-Arza MV. Effectiveness of dry needling on reducing pain intensity in patients with myofascial pain syndrome: a meta-analysis. J Tradit Chin Med. 2016;36:1-13. 5. Tough EA, White AR, Cummings M, Richards SH, Campbell JL. Acupuncture and dry needling in the man-agement of myofascial trigger point pain: a systematic review and meta-analysis of randomized controlled trial. Eur J Pain. 2009;13:3-10.

OPO98DIAGNOSIS OF NON–SMALL CELL CARCINOMA IN A PATIENT WITH UPPER-QUARTER PAINCraig P. HensleyPhysical Therapy and Human Movement Sciences, Northwestern University, Chicago, IllinoisBACKGROUND AND PURPOSE: While emphasis has been placed on screening for serious medical pathology during the initial evaluation, it is also im-portant for physical therapists (PT)s to screen for “red flags” throughout the episode of care. Further, patients with a presentation complicated by multiple issues, including central sensitization and/or biopsychosocial in-fluences, can challenge the clinician’s screening accuracy [1]. The purpose of this case report is to describe the differential diagnosis process and clinical reasoning of a patient with upper-quarter pain.CASE DESCRIPTION: A 59-year-old woman presented with a 5-month histo-ry of left thorax, cervical, and shoulder pain. She received multiple inter-ventions, including chest wall injections of Tordol and anti-inflammato-ry medications, which did not completely resolve her pain. Chest, cervical spine, and shoulder X-rays were negative. The patient reported multiple recent psychosocial stressors, including her husband recently being di-agnosed with cancer, mother with stroke, and the recent death of a close friend. She answered yes to the Whooley questions [2]. She reported an increase in dyspnea and sweating in the recent past, but stated both were improving. She endorsed smoking for 20 years, but quit 12 years prior. She denied any other red flags. Past medical history was significant for hy-pertension, diabetes mellitus type II, and asthma. Multiple activities were reportedly aggravating, including sleeping on the involved side, reaching overhead, rotating her neck, sitting, eating, coughing, and deep breathing. Shoulder, cervical, and thoracic active/passive range of motion (ROM) and joint mobility examination increased her pain. Allodynia was pres-ent throughout the left upper quarter. She tolerated the bike for 20 min-utes with no increase in symptoms and reported a decrease in pain with relatively stable vitals. Thus, manual therapy, therapeutic exercise, stress management, and pain education were initiated.OUTCOMES: The patient was seen for 5 visits over 35 days. Her shoulder flexion active ROM improved (85°-140°), pain improved (9-6 on nu-meric pain-rating scale) and QuickDASH score decreased (43%-34%). However, on her fifth visit, she reported an increase in pain, fatigue, sweating, dyspnea, and loss of appetite over the past week. The patient was sweating on her face. The primary care physician was notified and a CT scan of the chest was ordered. The patient was diagnosed with a non-small cell lung carcinoma.DISCUSSION: This case report highlights the importance of PTs evaluating for red flags throughout the course of care as pathological conditions can be masked in a presentation complicated by central sensitization and/or biopyschosocial stressors.REFERENCES: Mitchell ED, Rubin G, Macleod U. Understanding diagnosis of lung cancer in primary care: qualitative synthesis of significant event audit reports. Br J Gen Pract. 2013;606:e37-e46. Bosanquet K, Bailey D,

ative meniscus, meniscectomy, conservative treatment, arthroscopy, sur-gery, exercise therapy, rehabilitation, and meniscal tear.RESULTS: This systematic review utilized a total of ten peer-reviewed arti-cles. These ten articles were examined and grouped by their intended pur-pose. Four articles directly compared conservative therapy and APM. One article described a sham surgery compared to APM. Two articles exam-ined the clinical effectiveness of conservative therapy alone in treating the degenerative meniscus. One article observed the effects of APM alone on the treatment of the degenerative meniscus. The last 2 articles examined the effects of conservative therapy after APM was performed.CONCLUSIONS: In this study, the authors found no difference between APM and conservative therapy in the categories of pain, muscle strength, func-tion, and overall patient satisfaction after healing. Previous outcomes show that conservative treatment would incur less risk to the patient and be a more cost-effective and less traumatic option for patients with degen-erative meniscus. Therefore, it may be beneficial for the patient to under-go conservative therapy as an alternative to arthroscopic partial menis-cectomy, for symptom reduction and better functional outcomes.CLINICAL RELEVANCE: APM disrupts the innate tissues that protect the knee from further degenerative processes such as the progression of osteoar-thritis. If conservative therapy is ineffective in reducing patient symptoms, it can still serve to provide the patient with presurgical strengthening. Patient education is crucial in the patient’s choice of treatment for de-generative meniscal tears. Future research on this topic is recommended.

OPO97TRIGGER POINT DRY NEEDLING FOR A PATIENT PRESENTING WITH PLANTAR FASCIITIS FOLLOWING SURGICAL REMOVAL OF A STIEDA PROCESS AND STABILIZATION OF A TALAR FRACTURE: A CASE STUDYMargaret L. Hazlett, Joel E. BialoskyPhysical Therapy, University of Florida, Gainesville, FloridaBACKGROUND AND PURPOSE: Plantar fasciitis is a common musculoskeletal disorder of the foot with a lifetime incidence of 10% afflicting both sed-entary and highly active individuals. Trigger point dry needling (TDN) is a treatment for individuals experiencing musculoskeletal pain with lim-ited evidence for its effectiveness in individuals with plantar fasciitis. The purpose of this case study is to describe outcomes associated with the use of TDN as a supplemental intervention for a patient presenting for post-surgical rehabilitation in whom rehabilitation was limited by the develop-ment of plantar fasciitis associated with prolonged use of a walker boot.CASE DESCRIPTION: The patient was a 36-year-old man who presented to physical therapy for postoperative rehabilitation following surgical re-moval of a Stieda process and stabilization of a talus fracture. The patient was seen for 8 weeks of physical therapy directed by a standard post op-erative protocol and was progressing as expected. At this time, the patient developed signs and symptoms consistent with plantar fasciitis pain pre-venting progression and necessitating continued use of the post operative boot. Pain was rated as an 8/10 using a numeric pain rating scale and his Lower Extremity Functional Scale was 58/80. Trigger points were identi-fied in the adductor hallucis and flexor hallucis muscles and TDN was ini-tiated to these areas for 2 sessions over a 2-week period.OUTCOMES: Following 2 TDN treatments, patient reported 0/10 on pain and scored 80/80 of the LEFS which translated to 100% of maximal function, and was able ambulate without the post operative boot with full weight-bearing on his affected extremity.DISCUSSION: The addition of TDN to a standard physical therapy pro-gram was associated with complete functional recovery and absence of pain upon discharge in a patient in whom postoperative rehabilitation was limited by the onset of plantar fasciitis. This case is novel in describ-ing the supplemental use of TDN in a patient in whom the development of plantar fasciitis limited return to full function following an unrelated surgical procedure.REFERENCES: 1. Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM. Heel pain. Plantar fasci-


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Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NevadaPURPOSE/HYPOTHESIS: Temporomandibular dysfunction (TMD) is a com-mon orofacial condition, which often leads to restricted mandibular opening. In order for physical therapy intervention to be optimal, it is important to identify arthrokinematic limitations in individuals with TMD. Specifically, anterior translation of the mandibular condyle is a re-quired arthrokinematical component to achieve maximal mouth open-ing. To date, quantifying TMJ arthroknematics relies on advanced imag-ing techniques (eg, computerized tomography [CT]) or motion analysis systems, which are expensive and impractical for on-site clinical use. Ultrasonography could provide an inexpensive, more practical means of obtaining measurements of anterior translation of the mandibular con-dyle. The purpose of this study was to investigate the reliability of using ultrasound (US) imaging for measuring TMJ arthrokinematics (ie, ante-rior translation of the mandibular condyle) during mouth opening.NUMBER OF SUBJECTS: Twenty-eight subjects (mean ± SD age, 25.9 ± 4.1 years; 14 male, 14 female) with no current diagnosis of TMD.MATERIALS/METHODS: During day 1 of data collection, all 28 subjects were asked to repeatedly perform maximal mouth opening while a single ex-aminer placed a linear US transducer overlying the TMJ and the zygo-matic arch to record dynamic images of bilateral TMJs. On day 2 of data collection, the same US imaging acquisition procedure was performed on 6 of the subjects that participated in day 1 of data collection. Data anal-ysis was performed to determine (1) imaging processing reliability, and (2) imaging acquisition reliability. Reliability of imaging processing was determined by 3 examiners. Each examiner measured condylar transla-tional distance during mouth opening of 28 subjects on 2 separate days with at least 7 days apart. Averages on each side from both data process-ing days were analyzed to determine inter and intrarater reliability using intraclass correlation coefficients (ICCs). Standard errors of measurement (SEMs) of each examiner were also calculated. To determine intrarater reliability of US imaging acquisition (ie, transducer placement accura-cy), data obtain from day 1 and day 2 of data collection was analyzed us-ing ICCs and SEMs.RESULTS: Data analyses revealed excellent interrater reliability among the 3 examiners for measurements of both TMJs (ICC = 0.989-0.999). Excellent intrarater reliability for imaging processing was also achieved (ICC = 0.960-0.977; SEM, 0.704- 0.871 mm). Data also revealed excel-lent intrarater reliability for US imaging acquisition (ICC = 0.929-0.939; SEM, 1.214-1.268 mm).CONCLUSIONS: This is the first study assessing the reliability of using US imaging to measure anterior condylar translation in healthy adults. Our data demonstrated that anterior condylar displacement during mouth opening can be measured reliably using our US imaging approach.CLINICAL RELEVANCE: Our research provides an inexpensive, reliable mean of obtaining anterior translation of the mandibular condyle during mouth opening.

OPO101ACUTE EFFECTS OF WALKING ON THE DEFORMATION OF FEMORAL ARTICULAR CARTILAGEKai-Yu Ho, Jayson McClaren, Skyler Sudweeks, William R. McGeePhysical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada; Total Sports Medicine and Orthopedics, Las Vegas, NevadaPURPOSE/HYPOTHESIS: Knee osteoarthritis (OA) is characterized by a pro-gressive loss of the articular cartilage, increasing the amount of friction in the joint, resulting in pain and decreases in mobility and function. Additionally, it has been hypothesized that frontal plane knee malalign-ment (eg, varus, valgus) is associated with initiation/progression of OA. Previous studies show that static loading of the knee results in more car-tilage deformation in those with knee OA compared to healthy controls. Static loading of the knee is only proportional to their body weight, where-

Gilbody S, Harden M, Manea L, Nutbrown S, McMillan D. Diagnostic ac-curacy of the Whooley questions for the identification of depression: a di-agnostic meta-analysis. BMJ Open. 2015:e008913.

OPO99KINEMATIC ANALYSES OF THE TEMPOROMANDIBULAR JOINT DURING FUNCTIONAL MOVEMENTS AND JOINT MOBILIZATION: A CADAVERIC STUDYJing-Ching Sally Ho, Mei-ling Chiu, Shiubong Larry Ho, Ar-Tyan HsuDepartment of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California; Department of Physical Therapy, National Cheng Kung University, Tainan, Republic of ChinaPURPOSE/HYPOTHESIS: Temporomandibular disorder (TMD) is character-ized by pain and dysfunction of the temporomandibular joint (TMJ) and muscles of mastication. It affects 6% to 12% of the adult population [1]. Joint mobilization has been employed for managing TMD [2]. Recent re-views in the management of TMD failed to identify high-quality evidence and certainty of effectiveness for manual therapy [3,4,5]. No existing lit-erature has analyzed the biomechanical characteristics of TMJ mobiliza-tions,. therefore, purposes of this study were to investigate the kinematics of TMJ during jaw functional movements and during TMJ mobilization.NUMBER OF SUBJECTS: Nine fresh cadaveric head specimens were used.MATERIALS/METHODS: The specimen was mounted on a test frame with a 6-axis load cell. A Vicon Motion Analysis System was used to track move-ments of TMJ. Functional movements ( jaw opening, protrusion, retru-sion, and lateral deviations) were performed passively by a TMD special-ist (SH). Unilateral inferior glide with anteromedial translation (UIGAT), bilateral inferior glide with anterior translation (BIGAT), inferior glide with anterior rotation (IGAR), inferior glide with posterior rotation (IGPR), and lateral glide were performed. Jaw movements were tested again at the end of the experiment. The condylar rotation and translation of both left (LC) and right condyle (RC) were analyzed.RESULTS: During passive jaw opening the condyle rotated 16.1° ± 3.0° and moved anteriorly (LC, 1.88 ± 1.89 mm; RC, 2.24 ± 1.42 mm) and inferior-ly (LC, 3.87 ± 1.77 mm; RC, 3.53 ± 2.18 mm). During passive jaw deviation to the left, the left condyle moved posteriorly (1.04 ± 0.82 mm), laterally (1.34 ± 0.44 mm), and superiorly (0.71 ± 0.59 mm) and the right condyle moved anteriorly (1.32 ± 0.87 mm), medially (1.35 ± 0.48 mm), and in-feriorly (0.91 ± 0.54 mm). Similar patterns of condylar movements were observed during passive jaw deviation to the right. UIGAT and BIGAT produced anterior translation (2.59 ± 1.75 mm and 2.08 ± 0.97 mm) and inferior translation (1.72 ± 0.64 mm and 1.58 ± 0.52 mm) of the condyle. UIGAT and lateral glide produced lateral translation (1.61 ± 0.66 mm and 0.83 ± 0.44 mm). There were significant increase of condylar rota-tion (P = .008) and translation in the anterior (P = .011 in LC) and infe-rior directions (P = .021 in both LC and RC) between pre and posttest of jaw opening.CONCLUSIONS: During functional movements and TMJ mobilizations di-rections of condylar rotation and translation were consistent with intend-ed applications [2]. Results of the present study also suggest that UIGAT and BIGAT can be applied if anterior or inferior movement of the con-dyle or if jaw opening is limited and UIGAT and lateral glide, if the lateral movement of the condyle is limited.CLINICAL RELEVANCE: This study presented the kinematics of TMJ during functional jaw movements and during TMJ mobilization and therefore provided quantitative data for research references and clinical evidence to verify the effectiveness of the TMJ mobilization techniques.

OPO100RELIABILITY OF MEASURING ANTERIOR TRANSLATION OF THE MANDIBULAR CONDYLE DURING MOUTH OPENING USING ULTRASONOGRAPHYKai-Yu Ho, Brooke Basar, Danielle Hahn, Christensen J. Hardy


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painful LE of the PFOA group and the same side LE of matched con-trol participants was examined. A motion capture system was used to track LE motion during StDn and STS. Peak hip and knee joint veloci-ties during stance phase were determined. Peak isometric torque of the hip abductors, hip external rotators (ER), hip extensors, and knee exten-sors were measured with an instrumented dynamometer and normalized by mass and height. Data were analyzed with nonparametric statistics.RESULTS: Participant median age was 50 years (PFOA group) and 52 years (control group); all were female. Peak hip adduction velocity during StDn and peak knee extension velocity during STS were slower in the PFOA group than the control group (P<.05). All normalized muscle torques were lower in the PFOA group versus the control group (P<.01). Moderate positive relationships existed between hip ER torque and (1) hip flexion velocity during St Dn (r = 0.51, P = .02) and (2) knee abduction velocity during StDn (r = 0.63, P = .003). A moderate inverse relationship existed between hip ER torque and hip internal rotation velocity during StDn (r = –0.52, P = .02). A moderate inverse relationship existed between peak hip abductor torque and (1) minimal knee flexion velocity during STS (r = –0.64, P = .003) and (2) minimal hip flexion velocity during STS (r = –0.47, P = .04).CONCLUSIONS: Persons with PFOA had reduced hip and knee joint angular velocities during StDn and STS as well as lower peak isometric LE muscle torque. Significant associations between hip ER and hip abductor torques with hip and knee joint velocities indicate that weakness of these muscles may contribute to aberrant LE biomechanics during StDn and STS. The negative association between hip ER torque and hip internal rotation ve-locity during StDn indicates that hip ER weakness may contribute to poor LE control during stair descent in persons with PFOA.CLINICAL RELEVANCE: Persons with PFOA have proximal LE muscle weak-ness and reduced LE joint angular velocities during tasks of stair descent and STS. Future research should study the effect of a strengthening pro-gram for persons with PFOA on joint velocities and pain during func-tional tasks.

OPO103DOES THE PRESENCE OF RADIATING PAIN IN A COHORT OF CARE-SEEKING PATIENTS WITH NECK PAIN INFLUENCE OUTCOME?Joshua Holskey, Charles A. Thigpen, Chad E. Cook, Thomas R. Denninger, Timothy McHenryResearch and Analytics, ATI Physical Therapy, Greenville, South Carolina; Department of Orthopedics, Duke University, Durham, North Carolina; Department of Orthopedics, Greenville Health System, Greenville, South CarolinaPURPOSE/HYPOTHESIS: Previous literature has established the presence of radiating pain in patients with neck pain as a prognostic indicator for worse outcome. The purpose of this analysis of a cohort of patients is to establish if difference exists in duration of care and outcomes in patients presenting to physical therapy with nonradiating and radiating neck pain.NUMBER OF SUBJECTS: The nonrandomized comparative study involved a cohort of 200 patients with neck pain with or without radiating upper ex-tremity symptoms who received guideline oriented care by physical ther-apists over a 3-year period.MATERIALS/METHODS: The data included patients who were seen via direct access or through referral. Baseline measures of pain, disability (Neck Disability Index), depression and quality of life were captured for each subject. Final outcomes measures captured include pain and the NDI. Comparative analyses between groups were performed for all baseline measures (using a t test/chi-square) and for discharge percentage change scores for pain and disability (using an analysis of covariance [ANCOVA]; α = .05).RESULTS: Of the 200 patients enrolled, 135 (67.5%) had neck back pain without radiation and 65 (32.5%) had radiating symptoms. No differenc-es existed age of patients in each group. Differences existed in number of PT session with those with radiating symptoms being seen 1.8 more visits

as walking produces forces in the knee that are 2 to 3 times body weight. This may result in greater cartilage deformation. The purpose of our study was to compare the acute effects of walking on the femoral cartilage de-formation between individuals with and without knee OA and determine whether knee alignment is associated with cartilage deformation.NUMBER OF SUBJECTS: Ten subjects without OA (5 female, 5 male; mean ± SD age, 55.0 ± 1.8 years; weight, 78.8 ± 14.0 kg; height, 1.8 ± 0.2 m) and 7 subjects with OA (4 female, 3 male; age, 55.4 ± 5.2 years; weight, 94.0 ± 13.1 kg; height, 1.7 ± 0.1 m) were recruited.MATERIALS/METHODS: Each subject underwent X-ray and magnetic res-onance imaging (MRI) assessment. For X-ray assessment, participants with Kellgren-Lawrence grades 2 to 3 were assigned to the OA group whereas subjects with grades 0 to 1 were assigned to the control group. During MRI assessment, 3 T, frontal-plane MRI was obtained before and immediately after 30 minutes of treadmill walking at 3 to 4 mph. Knee alignment was obtained by measuring the angle between the long axes of femur and tibia using a goniometer. To obtain cartilage deformation post-walking, the medial and lateral femoral cartilage of the weight-bearing ar-eas was segmented on subjects’ MRI. Cartilage thickness was quantified by computing the average perpendicular distance between opposing vox-els defining the edges of the femoral cartilage. Independent t tests were used to compare cartilage deformation (ie, percent changes in medial and lateral cartilage thickness) postwalking between the 2 groups. Pearson correlation coefficients were used to assess the association between carti-lage deformation and knee alignment of all subjects.RESULTS: Independent t tests revealed no significant difference in cartilage deformation between OA group and control group in medial (P = .843) or lateral (P = .660) femur. Pearson correlation coefficient analyses revealed a significant correlation between lateral femoral cartilage deformation and increased knee valgus alignment (r = 0.505, P = .039).CONCLUSIONS: This is the first study assessing the acute effects of walking on femoral cartilage deformation in persons with and without knee OA. Although there was not a difference in cartilage deformation between the 2 groups, we found that knee valgus was related to lateral femoral carti-lage deformation postwalking.CLINICAL RELEVANCE: Our findings provide further understanding of the contribution of LE alignment and development of OA. This research can impact the interventions for individuals with knee OA.

OPO102PERSONS WITH PATELLOFEMORAL OSTEOARTHRITIS HAVE REDUCED HIP AND KNEE JOINT VELOCITIES DURING FUNCTIONAL TASKS AND DECREASED PROXIMAL LOWER EXTREMITY STRENGTHLisa T. Hoglund, Neil B. Sheth, Joshua R. Orlow, Niraj A. Patel, Michael Polejaev, Laura Pontiggia, John D. Kelly, James CareyPhysical Therapy, University of the Sciences, Philadelphia, Pennsylvania; Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania; Mathematics, Physics, and Statistics, University of the Sciences, Philadelphia, Pennsylvania; Orthopedic Surgery, University of Pennsylvania, Philadelphia, PennsylvaniaPURPOSE/HYPOTHESIS: Patellofemoral osteoarthritis (PFOA) was reported present in 69% of adults approximately 40 years with chronic knee pain [1]. PFOA causes significant pain and disability [2,3]. Altered lower ex-tremity (LE) biomechanics may contribute to PFOA development or pro-gression. But there are conflicting reports of the presence of aberrant LE biomechanics in persons with PFOA [4-8]. Altered hip or knee joint an-gular velocity may be an indication of poor LE control, such as valgus LE collapse in persons with patellofemoral pain. The purpose of this study was to examine hip and knee joint peak angular velocities during step-down (StDn) and sit-to-stand (STS) tasks in persons with PFOA versus pain-free controls.NUMBER OF SUBJECTS: Twenty.MATERIALS/METHODS: A cross-sectional study compared 10 persons with painful PFOA to 10 age- and sex-matched pain-free adults. The most


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helped the PT educate the patient on the nature of the symptoms, the in-ability to progress with rehabilitation, the need for further orthopaedic referral, and to better understand the prognosis for clinical management, which included both PT and orthopaedic care.REFERENCES: 1. Croy T, Cosby N, Hertel J. Active ankle motion may re-sult in an anterior talar positional fault in individuals with chronic ankle instability and ankle sprain copers: a preliminary study. J Man Manip Ther. 2013;21:127-133. 2. Croy T, Saliba S, Saliba E, Anderson M, Hertel J. Talofibular length increases following ankle sprain: a stress ultrasonog-raphy study of ankle laxity. J Sport Rehabil. 2013;22:257-263. 3. Croy T, Saliba S, Saliba E, Anderson M, Hertel J. Differences in lateral ankle lax-ity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. J Orthop Sports Phys Ther. 2012;42:593-601. 4. Pesquer L, Guillo S, Meyer P, Hauger O. US in ankle impingement syndrome. J Ultrasound. 2014;17:89-97. 5. Radwan A, Bakowski J, Dew S, Greenwald B, Hyde E, Webber N. Effectiveness of ultrasonography in diagnosing chronic lateral ankle in-stability: a systematic review. Int J Sports Phys Ther. 2016;11:164-174.

OPO105THE EFFECTS OF BALANCE VERSUS STRENGTH TRAINING ON ACTIVE AND PASSIVE ANKLE POSITION SENSE IN INDIVIDUALS WITH ANKLE INSTABILITYYou-jou Hung, Jacob MillerPhysical Therapy, Angelo State University, San Angelo, TexasPURPOSE/HYPOTHESIS: Ankle instability is a common problem for individ-uals with a history of ankle sprains. It was suggested that altered motor control due to less accurate ankle position sense can contribute to recur-rent injuries. The purpose of this study was to compare the training out-come of 2 ankle rehabilitation protocols on active and passive ankle po-sition sense.NUMBER OF SUBJECTS: Seventeen subjects (19-30 years old) with a histo-ry of ankle sprains volunteered for the study. Their Cumberland Ankle Instability Tool (CAIT) score ranges from 10 to 27 for the participants at the baseline testing session.MATERIALS/METHODS: Subjects were randomly assigned to 1 of the 2 groups: (1) balance training, and (2) strength training. The supervised training lasted for 30 minutes each time, 2 times a week for 4 weeks. For balance training, exercise progressed from standing on both legs to sin-gle leg, from standing on stable surfaces to unstable surfaces, and from standing with visual feedback to standing with eyes closed. For strength training, subjects engaged resistance training for their ankle joint mus-cles, emphasizing ankle dorsiflexors and everters. Ankle position sense was examined with the Active Reproduction of Active Positioning and Passive Reproduction of Passive Positioning protocols. A dual-axis ankle electronic goniometer was used to examine ankle angles. Two-way analy-sis of variance with 1 between-group factor and 1 repeated-measures fac-tor was used to analyze the data.RESULTS: Baseline examination indicated that there is no ankle stability difference between the 2 treatment groups using their CAIT scores (F = 0.366, P>.55). For active ankle position sense, there is no difference be-tween balance and strength training protocols (F = 0.086, P>.77), no dif-ference among pre, post and follow-up testing (for ankle stability index (F = 1.558, P>.23), and no training-testing interaction (F = 1.026, P>.35). For passive ankle position sense, there is no difference between balance and strength training protocols (F = 0.304, P>.59), no difference among pre, post and follow-up testing (for ankle stability index (F = 3.350, P>.06), and no training-testing interaction (F = 1.172, P>.31).CONCLUSIONS: Balance training is a common intervention for individuals with ankle instability. Results of the present investigation indicate that there is no treatment effect difference between a 4-week-long balance and strength training programs on active or passive ankle position sense. In addition, ac-tive ankle position sense has a better functional significance over passive position sense. However, neither active nor passive ankle position sense im-

(P = .015). Baseline pain and disability were not significantly difference, nor was reductions in disability. Both groups experienced reductions in pain and disability that exceeded statistical significance and minimally clinically important difference.CONCLUSIONS: Despite the commonly accepted belief that the presence of radiating upper extremity symptoms in patients with neck pain is indica-tive of worse outcome, our findings did not support this. This difference may be due to continued visits if the patient demonstrated progression of symptoms where prior research has limited the number of PT visits. This suggest a capitated number of visits for all patients is not an effec-tive strategy to determine if conservative treatment is definitive for all patients.CLINICAL RELEVANCE: Clinicians should consider that some patients radiat-ing symptoms may have different lengths in episode of care but can be ex-pected to reach similar functional levels at discharge.

OPO104THE CLINICAL USE OF MUSCULOSKELETAL ULTRASOUND IN THE MANAGEMENT OF ANTEROLATERAL ANKLE IMPINGEMENT: A CASE REPORTAmanda J. Humphrey, Ross Schumer, Theodore CroyUS Army-Baylor University Doctor of Physical Therapy Program, San Antonio, Texas; F. Edward Hebert School of Medicine, Uniformed Services University of Health Science, Joint Base San Antonio, Fort Sam Houston, TexasBACKGROUND AND PURPOSE: Sports-related ankle injuries are problematic and result in persistent pain and disability. Musculoskeletal ultrasound (MSK US) imaging can augment the clinical examination and help guide patient education and management. The purpose of this case study is to describe the clinical presentation, diagnosis and management of a female Soldier who underwent MSK US, physical therapy (PT) and arthroscop-ic ankle surgery.CASE DESCRIPTION: The patient is a 24-year-old woman with a past history of recurrent ankle sprains who injured her ankle playing soccer where she was slide tackled and forced into end range plantar flexion. Immediately postinjury she reported to the ER where radiographs were obtained and she was placed on crutches for 2 weeks. She underwent Physical Therapy for 3 months. After completing a bout of conservative care she still had persistent and unresolved complaints of sharp anterolateral ankle pain with dorsiflexion, running, and stair descent, which did not improve de-spite PT intervention. MSK US demonstrated an intact anterior talofib-ular ligament and a bony fragment on the dorsal neck of the talus, which engaged the talocrural joint during dorsiflexion. This lesion was con-firmed on MRI. Ankle arthroscopy confirmed an 8-mm bony loose body with soft tissue attachment to the dorsal-lateral talar neck with surround-ing synovitis. The articular cartilage was intact without any evidence of a donor site. Dorsiflexion under arthroscopic visualization demonstrat-ed bony impingement on the anterior distal tibia. The loose body was re-moved, and a limited synovectomy with osteoplasty of the talar neck was performed to allow full, unrestricted dorsiflexion without impingement. The patient was placed in a cam walker weight bearing as tolerated for 3 weeks and allowed to perform early full range of motion.OUTCOMES: MSK US augmented the PT clinical exam with this patient. This provided the PT and the patient with a visualization of the loose body and capsular synovitis that contributed to her symptoms. This aid-ed the PT in educating her and helped to adjust her return to sport and functional expectations. The patient demonstrated full passive dorsiflex-ion under anesthesia after the synovitis and loose body were removed. She is currently following an uncomplicated postoperative clinical course.DISCUSSION: MSK US in conjunction with clinical examination can aid in patient education and prognosis management with clinical conditions that may require referral and subsequent ankle surgery. The patient dem-onstrated MSK US findings consistent with an impinging lesion in the anterior ankle, corroborated by MRI and arthroscopy. These findings


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Justin L. Staker, Paula M. LudewigPhysical Medicine and Rehabilitation, University of Minnesota, Minneapolis, Minnesota; Program in Physical Therapy, University of Minnesota, Minneapolis, MinnesotaPURPOSE/HYPOTHESIS: Shoulder pain is a prevalent musculoskeletal com-plaint, with estimates of up to 26% of people experiencing shoulder pain during their lifetime. Scapulothoracic exercise interventions are com-monly employed clinically for these patients. The purpose of this study was to determine any differences in EMG and kinematics between shoul-der exercises completed with and without incorporation of scapulothorac-ic training in subjects with shoulder pain.NUMBER OF SUBJECTS: Eleven subjects (5 female; average age, 28 years; 8 right shoulders) with shoulder pain meeting clinical inclusion/exclusion criteria.MATERIALS/METHODS: Five exercises: I’s, T’s, Y’s, external rotation with theraband (ERT), and external rotation with weight (ERW) were com-pleted under 3 conditions: (1) without specific scapulothoracic instruc-tions, (2) with scapular manual and verbal guidance, and (3) with scap-ular verbal guidance alone. Electromagnetic surface sensors tracked the trunk, clavicle, scapula, and humeral kinematics, while electromyograph-ic (EMG) sensors captured muscle activity of the upper trapezius (UT), lower trapezius (LT), middle and posterior deltoid, and serratus anterior muscles (SA). EMG data were normalized as a percentage of maximum contraction. A one-way repeated measures ANOVA compared the condi-tions within subjects. Tukey follow-up tests were used in the presence of significant condition effects.RESULTS: Significant (P<.05) changes in position, displacement, and EMG were recorded across conditions for several exercises with scapulothorac-ic training. Clavicular elevation position was reduced 1° during ERT, I and Y exercises. Clavicular retraction displacement increased during ERT, ERW, I and T exercises (4°-5°). Scapular internal rotation position sig-nificantly decreased (4°-8°) during ERT between the control and both guidance conditions, and during I exercises between control and manual guidance. Electromyography showed significant changes during ERT and ERW exercises for LT magnitude (16%-38% increase) as well as UT to LT ratio (10%-11% reduction). The SA magnitude significantly increased 3%-12% during ERT and T exercises, in addition to a significant reduc-tion (17%) in the UT to SA ratio during ERT exercises.CONCLUSIONS: Results support that manual and verbal guidance can pos-itively influence muscle activity and motion during scapular-focused shoulder exercises. Changes seen with the 2 guidance conditions were consistent with those targeted. This data suggests that manual and ver-bal guidance during scapulothoracic exercises can positively affect scapu-lothoracic kinematics and EMG activation of scapulothoracic muscula-ture. Future studies should work to expand the generalizability through larger sample sizes and a range of clinician expertise providing manual and verbal guidance.CLINICAL RELEVANCE: Clinicians should consider using manual and verbal scapular guidance to improve scapular exercise performance in individu-als with shoulder pain.

OPO108DRY NEEDLING IN THE UPPER THORAX: HAND DOMINANCE DOES NOT AFFECT THE DISTANCE TO THE LUNGSAaron W. Johnson, Ulrike H. MitchellBrigham Young University, Provo, UtahPURPOSE/HYPOTHESIS: Dry Needling (DN) has gained popularity and its use in physical therapy is increasing. One concern associated with DN is the risk of an inadvertent piercing of the thorax pleura leading to lung col-lapse. It is important to understand the typical distance to the pleura and factors that will alter this distance, especially as the use of DN increases. For example, the dominant limb may have larger muscles. The aim of this study was to present data on the distance from the skin to the lungs in 3 locations in the upper thorax, using ultrasound imaging (US) and to de-

proved at the completion and 1 month after the 4-week intervention.CLINICAL RELEVANCE: It was reported that ankle balance training may en-hance ankle proprioception and stability. However, the current study sug-gests that the improvement of ankle stability after training may be the result of other factors (eg, enhanced muscle/ligament strength and supra-spinal control) instead of improved ankle position sense.

OPO106DOES HIP STRENGTHENING DECREASE PAIN AND INCREASE FUNCTIONAL OUTCOMES IN WOMEN WITH PATELLOFEMORAL JOINT DYSFUNCTION? A SYSTEMATIC REVIEWEllen Jackson, Drew Lollar, Josh Lopez, Morgan Ogale, Tom SneedSouthwest Baptist University, Bolivar, MissouriPURPOSE/HYPOTHESIS: Since Title IX was signed into law in 1972, the amount of females participating in high school athletics has increased 902% and in collegiate sports 456%. With this increased activity lev-el, there has been an increase in injury, patellafemoral joint dysfunc-tion, seen at the knee joint more prevalent in women. The common ap-proach to intervention for this has been to focus on the knee joint itself with strengthening and taping to help with the strengthening. Recently a more global approach has been introduced incorporating proximal mus-cle strengthening at the hip. As this approach develops, the question aris-es: does hip strengthening decrease pain while increasing functional out-come measures in women with patellofemoral joint dysfunction?NUMBER OF SUBJECTS: Three hundred fifty-four.MATERIALS/METHODS: Five collections of search terms were used to search databases resulting in 206 studies identified. The number of studies af-ter duplicates were removed resulted in 49 studies. The 49 studies were screened via title and abstract for relevance and inclusion criteria of fe-male subjects diagnosed with patellofemoral joint dysfunction and a hip-strengthening component of rehab. After this screening, 10 studies re-mained. The 10 studies were reviewed in full text leading to an additional 3 studies excluded. The 7 selected studies were evaluated to determine level of research and quality of study.RESULTS: All studies were considered high level design being level II ran-domized controlled trials. Out of the 7 studies, 3 indicated strong qual-ity of study, 3 moderate quality of study, and only 1 showed weak quality. Subjects placed in groups with a hip strengthening component in their treatment had a decrease in pain on the VAS and an increase in function via LEFS and isometric strength measures. Out of the 7 studies, 5 used the VAS, 5 used the LEFS, and 4 used isokinetic strength testing as out-come measures. The studies using VAS reduced scores from average 6.4 to 1.4, a 77.7% improvement. The studies using LEFS increased scores from 53.8 to 70.3, an average of 30.6% improvement. The studies us-ing isometric strength all showed improvement with an average increased strength of 25.9% compared to controls which decreased 4.3%.CONCLUSIONS: Hip strengthening exercises should be included in the treat-ment of patellofemoral joint dysfunction. Closed chain exercises that in-clude the hip and the knee should also be used during treatment.CLINICAL RELEVANCE: Based upon the results of the studies reviewed, look-ing at the number of subjects who achieved positive outcomes with a hip strengthening component added to their treatment, it can be inferred that this approach should be added to the physical therapy protocol. Through adding a hip strengthening component to the rehab process as well as working at the knee joint itself, the patient is receiving a global treatment approach. With the patient participating in a global treatment approach to their rehab process, better outcomes can be attained by focusing inter-ventions at more than 1 joint.

OPO107THE IMPACT OF SCAPULOTHORACIC EXERCISE TRAINING ON INDIVIDUALS WITH SHOULDER PAIN: AN EMG AND KINEMATIC INVESTIGATIONLaura E. Jacobs, Tom P. Ebert, Noah Fessler, Amy Evans,


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week. The MJ group performed bench press. The IJ group performed serratus punch, triceps extension, and shoulder flys. Following the train-ing period, all groups were posttested using the same outcome measures. Between group differences were determined using 1-way ANOVAs for each outcome measure.RESULTS: A statistically significant difference of 4.5 repetitions (P<.05) were found between the MJ group and the control group in the PU test with the MJ group performing more, though there was no significant dif-ference between MJ and IJ. No other differences between training groups were found from pre to posttesting in the other 5 outcome measures. There was significant within group improvement in all outcome measures in both training groups.CONCLUSIONS: All groups improved in all outcome measures, though MJ training resulted in significant improvement in PU performance when compared with the control group. Neither MJ or IJ training resulted in improvements in power as demonstrated by the seated shot-put. Studies comparing MJ versus IJ training in the LE found MJ training to be su-perior. This study found no significant difference between the training methods in the UE. MJ training was shown to be an effective method of improving shoulder strength and endurance in healthy 18- to 40-year-old individuals via the PU test outcome measure. Further research on train-ing for pathological individuals and on the best methods for improving shoulder power is needed.CLINICAL RELEVANCE: Improvement in PU max repetitions is best achieved with MJ exercises, rather than multiple IJ exercises. Further research should be done on subjects with pathological shoulders to determine the clinical significance of these treatment programs.

OPO110COMPARATIVE EFFECTS OF MIRROR SQUAT EXERCISE AND HIP-STRENGTHENING EXERCISE ON PATELLOFEMORAL PAIN SYNDROMEPark Joo-Hee, Sungyong Kang, Hye-Seon JeonDepartment of Physical Therapy, Yonsei University, Wonju, Republic of KoreaPURPOSE/HYPOTHESIS: Patellofemoral pain syndrome (PFPS) is a common knee-related complaint in the sporting and general populations. Although many researchers have suggested a variety of clinical intervention meth-ods, optimal treatments for the PFPS remain unclear. The main purpose of this study was to compare recently recommended exercise methods; a mirror squat exercise (MSE) and a hip-strengthening exercise (HSE), in pain, function, kinematics, and activation onset of gluteus medius in fe-males with PFPS.NUMBER OF SUBJECTS: Thirty-two females with PFPS participated in this study (16 per group) and conducted 3 times per week for 12 exercise ses-sions over the course of 4 weeks.MATERIALS/METHODS: This study assessed pain using the visual analogue scale (VAS), and self-reported function using lower extremity function-al scale (LEFS). Kinematics of lower extremity (using 3-D motion anal-ysis) assessed hip adduction (HADD), hip internal rotation (HIR), knee adduction (KADD), and contralateral pelvic drop (CPD). Activation on-set of gluteus medius was assessed using a surface EMG. The kinematics and activation onset were measured as participants performed a single-leg squat (SLS) test and a step descent test. All assessments were repeat-edly measured at pretest, posttest, and 1-month and 3-month follow-ups.RESULTS: In results of the SLS test, all kinematic variables (HADD, HIR, KADD and CPD) after 4 weeks of exercise showed significant improve-ment in both groups. Especially, patients assigned to the MSE group showed greater improvement and maintained it longer (up to 3 months) than those in the HSE group. In activation onset of the gluteus medius, both the MSE and HSE groups showed significantly earlier activation on-set at posttest and maintained to 1 month.CONCLUSIONS: After 4 weeks of exercises, both groups showed significant improvement in pain, function, kinematics, and activation onset. More specifically, in the SLS test, patients assigned to the MSE group showed

termine if there was a significant difference in this distance based on the side of hand dominance.NUMBER OF SUBJECTS: Thirty individuals (9 women, 21 men; mean ± SD age, 25.5 ± 4.6 years; BMI, 28 ± 3 kg/m2) participated in the study.MATERIALS/METHODS: Subjects laid prone on a plinth with the arms posi-tioned at their sides. The spinous processes of thoracic vertebrae were marked for referencing during the imaging. On both the right and left side of the thorax, the thorax pleura, adjacent ribs, and over-lying tissue were visualized with US and a brief video was recorded noting the move-ment of the lungs. From the recorded video, a still image was selected and the distance to the pleura was measured using the US unit’s internal soft-ware. Images were captured at the location of the levator scapulae (LS), rhomboid minor (Rmin) and lower rhomboid major (Rmaj) in 2 condi-tions, with and without a supportive towel placed under the shoulder. ANOVA was run to determine differences between the side of dominant and nondominant hands.RESULTS: There was no significant difference, based on hand dominance, in distance to the pleura at any of the locations assessed with or without the supportive towel under the shoulder (P values between .2 and .9) The average distance to the pleura, no towel, was LS 4.05 ± 0.8 cm, Rmin 3.5 ± 0.8 cm, Rmaj 2.6 ± 0.5 cm. The average distance to the pleura with sup-portive towel was LS 4.6 ± 0.9 cm, Rmin 4.1 ± 0.8 cm, Rmaj 3.1 ± 0.6 cm.CONCLUSIONS: There is not a significant difference in the distance to the lung pleura at the locations of the LS, Rmin, or Rmaj based on the side of hand dominance. Depth to the pleura appears to be fairly consistent be-tween right or left sides of the body in young health adults.CLINICAL RELEVANCE: Physical therapist practicing DN need to have detailed knowledge of the anatomy in the body regions they treat in order to min-imize risk associated with DN, such as pneumothorax. It is important to understand the effect of various factors that may alter the distance to the lung pleura. Hand dominance does not appear to make a significant dif-ference in this depth. Other factors, such as body composition, sex, age, should be examined, on their influence of this distance. Caution and res-ervation need to be exercised when DN muscles that have close approxi-mation to the lungs.

OPO109THE EFFECTS OF ISOLATED JOINT VERSUS MULTIPLE JOINT TRAINING ON THE SHOULDERCharles E. Jones, Evan McGuire, Tim Mettenburg, Brittney Hill, Nancy Henderson, Haley S. Worst, Keri Mans, George J. DaviesPhysical Therapy, Armstrong State University, Savannah, GeorgiaPURPOSE/HYPOTHESIS: Multi-joint (MJ) and isolated-joint (IJ) training are 2 strengthening techniques used in upper extremity (UE) rehabilitation and performance enhancement. The literature comparing IJ and MJ ex-ercises for the UE is mixed and focused more on the lower extremity (LE). The purpose of this study was to determine if significant differences ex-isted between these MJ and IJ training in the UE. We hypothesized that MJ training will have greater effects on the outcome measures compared to the IJ training.NUMBER OF SUBJECTS: Fifty Armstrong State University students, between 18 and 40 years old, completed the study. Subjects were excluded if they had any current shoulder pain or pathology, previous history of UE or cer-vical surgery/injury.MATERIALS/METHODS: The study was a prospective experimental, pretest-posttest controlled study comparing the effectiveness between 2 multi-joint and isolated training programs in the UE. Seventy-nine volunteers were recruited via convenience sampling. Following pretesting which con-sisted of 6 outcome measures (push up (PU) test, seated shot put, Closed Kinetic Chain Upper Extremity Stability Test, handheld dynamometry: triceps, serratus anterior, horizontal abduction). Sixty-three subjects were randomized into 3 groups: MJ training, IJ training, or control. Subjects in the training groups performed 6 weeks of training sessions twice per


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nique into a comprehensive treatment plan for the patient.

OPO112A CASE STUDY REVIEWING THE PRESENTATION OF SPINAL ACCESSORY NERVE PALSY IN A WORKMAN’S COMPENSATION CASEJennifer Junkin, Margaret WicinskiBenchmark Physical Therapy, Conyers, Georgia; University of St Augustine, St Augustine, FloridaBACKGROUND AND PURPOSE: Spinal Accessory Nerve Palsy can occur after a cervical surgery, blunt injury to the neck, or trauma resulting in a cervi-cal stretch or traction injury. The spinal accessory nerve is also known as the 11th cranial nerve and innervates the trapezius and sternocleidomas-toid. Damage to the nerve can cause motor dysfunction to the trapezius or sternocleidomastoid muscles with marked muscle wasting, poor shoul-der girdle strength, scapular dyskinesis, marked scapular depression and protraction of the affected shoulder. The purpose of this case study was to examine the steps necessary for differential diagnosis necessary for spinal accessory nerve palsy as well as the rehab program utilized for full func-tional return to work.CASE DESCRIPTION: The patient was a 30-year-old male electrical engineer referred to physical therapy with a physician referral of an upper trap strain. The patient was injured on the job while swinging 1000-lb electri-cal boxes on a pulley system. The patient’s arm got caught on the box and the head was pushed the opposite way resulting in a neck traction mecha-nism of injury. The patient had a difficult time with work over the follow-ing 2 days and was sent to an urgent care by his safety director. A work-man’s comp claim was filed. The physician at the urgent care referred the patient to physical therapy for 6 visits with a diagnosis of an upper trap strain. The patient presented to PT at his initial visit with his arm in a sling, a marked depression of his right shoulder compared to his left, atro-phy in right scapulothoracic region, significant scapular winging, inability to elevate or retract scapula, and inability to elevate his shoulder past 90°. The patient also had general UE weakness, poor grip strength and signifi-cant pain in right upper trap region.OUTCOMES: Significant changes were seen during treatment over a 3 month period. Changes were made with the QuickDASH subjective ques-tionnaire, grip strength, shoulder AROM, and postural changes which were documented with photographic evidence throughout care (pictures taken at initial evaluation, mid-treatment, and at discharge). Patient re-turned to work at full-time, full-duty.DISCUSSION: Spinal Accessory Nerve Palsy is a rare condition to see in the outpatient physical therapy realm and a difficult case to treat. This case was interesting due to differential diagnosis of possible shoulder patholo-gies, as well as the patient being a workman’s comp case with 6 initial au-thorized visits. A thorough examination is necessary for correct diagnosis as well as effective communication with workman’s comp regarding di-agnosis. An effective rehab program is essential for successful treatment with a return to work emphasis.REFERENCES: 1. Kelley MJ, Kane TE, Leggin BG. Spinal accessory nerve palsy: associated signs and symptoms. J Orthop Sports Phys Ther. 2008;38:78-86. 2. Chan PK, Hems TE. Clinical signs of accessory nerve palsy. J Trauma. 2006;60:1142-1144. 3. Koybasioglu A, Bora Tokcaer A, Inal E, Uslu S, Kocak T, Ural A. Accessory nerve function in lateral selec-tive neck dissection with undissected level IIb.ORL J Otorhinolaryngol Relat Spec. 2006;68:88-92. 4. Kozin F. Injuries of the brachial plexus. In: Iannotti J, Williams GR, eds. Disorders of the Shoulder: Diagnosis and Management. Philadelphia, PA: Lippincott Williaims and Wilkins; 2007. 5. Orhan KS, Demirel T, Baslo B, et al. Spinal accessory nerve function af-ter neck dissections. J Laryngol Otol. 2007;121:44-48.

OPO113A COMPARISON OF COMMON TAPING TECHNIQUES IN THE MANAGEMENT OF PATELLOFEMORAL PAIN SYNDROME IN COLLEGE-AGED INDIVIDUALSRumit S. Kakar, Linda K. Annan, Andrew Claypool,

greater improvement that were maintained longer (up to 3 months) than those of the HSE group. Likewise, kinematic findings in stair descent test also showed that MSE promoted greater improvement with longer main-tenance (up to 1 month) than HSE. In the activation onset of the glute-us medius, both groups showed earlier activation onset at posttest and that effects maintained to 1 month. Regarding pain and function, MSE showed superior improvement and longer maintenance (up to 1 month) than HSE.CLINICAL RELEVANCE: The present study suggests that when MSE and HSE are performed for 4 weeks, MSE is more effective than HSE on pain, function, and kinematics in females with PFPS.

OPO111SPINAL MANIPULATION INCREASES MOTOR CORTEX ACTIVITY IN HEALTHY ADULTS: PRELIMINARY RESULTS FROM AN FMRI STUDYMax Jordon, Sheri P. Silfies, Paul F. Beattie, Jennifer M. Vendemia, Scott A. VendemiaUniversity of South Carolina, Cayce, South Carolina; Physical Therapy, Drexel University, Philadelphia, PennsylvaniaPURPOSE/HYPOTHESIS: Proposed mechanisms underlying the affects of spi-nal manipulation (SM) include biomechanical and neurophysiological changes to sensory and motor systems [1]. To date, much of the work associated with motor system change has been focused on peripher-al changes or has indirectly assessed central changes. While it has been shown that SM can alter cerebral response to pain [2] and therapeutic neuroscience education can increase motor cortex activation [3], there is a paucity of data on the effects of SM on motor cortex activation. No study to date has used functional magnetic resonance imaging (fMRI) to as-sess changes in the motor cortex after SM. Therefore, the purpose of this study was to measure the hemodynamic changes in the motor cortex im-mediately after SM associated with trunk muscle activation during per-formance of trunk movements in the scanner. Previous work has shown that SM can increase trunk extensor muscle activation [4], therefore, we hypothesize that some of this increase was cortically driven by an increase in motor cortex activation.NUMBER OF SUBJECTS: Eight.MATERIALS/METHODS: Eight participants, 2 with a history of low back pain (5 female; mean ± SD age, 28.6 ± 7.2 years) performed 4 trunk move-ment tasks while undergoing brain functional imaging: supine bilateral and unilateral modified bridging and abdominal tightening. These tasks were chosen specifically to engage the musculature of the lumbopelvic region. A block design was utilized in which each task was performed 6 times in random order. Participants were then removed from the scanner and received bilateral side lying, rotatory manipulations directed at L4-5. Trunk movements were repeated in the scanner post manipulation. T1-weighted structural scans were also completed. All scans were performed on Siemens Trio 3-T MRI. FMRI data processing was carried out using FEAT (FMRI Expert Analysis Tool) with higher-level analysis in FLAME (FMRIB’s Local Analysis of Mixed Effects) [5]. A region of Interest (ROI) analysis was used to determine specific changes that occurred in the mo-tor cortex. The ROI was generated in FSLView (FMRIB Software Library View) using the Juelich Atlas and the analysis run in FEATQuery.RESULTS: The fMRI data revealed a significant increase in the blood-ox-ygen-level dependent (BOLD) activation in the motor cortex after SM. This increase in the BOLD activation was seen for all 4 tasks. Further ex-ploration of specific regions within the motor cortex demonstrated that the abdominal task response was spatially different from the other tasks.CONCLUSIONS: The data from this preliminary study suggests that SM may result in increased activation of the motor cortex in healthy adults with no current pain. This study lends to the evidence that SM exhibits not just a biomechanical effect to local structures but can also effects supra-spinal structures.CLINICAL RELEVANCE: Further understanding of the mechanisms behind spi-nal manipulation can assist the clinician with the integration of this tech-


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study was to compare long-term results between 3 treatment groups (mo-bilization with movements [MwMs], passive joint mobilization [PJM] and electrotherapy) to determine which treatment is most effective in pa-tients with knee OA.NUMBER OF SUBJECTS: Seventy-two consecutive patients (mean ± SD age, 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to 1 of 3 treatment groups: MwMs, PJM and electrotherapy.MATERIALS/METHODS: A double-blinded randomized clinical trial with parallel design was conducted in patients with knee OA. The prima-ry outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary out-come measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dy-namometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Comparisons of score changes measuring im-provements in level of function, ROM values and muscle strength and decrease in pain levels were carried out using 2-by-2 repeated-measures ANOVA with time (baseline and end of treatment). To test the effects on functional outcomes, pain, ROM values and muscle strength at each time point (end of treatment to 1-year follow-up) as the within-subject vari-able and group (MwMs, PJM and electrotherapy) as the between-sub-ject variable, we used a mixed-model repeated-measures analysis of co-variance (ANCOVA) with baseline values, sex and duration of symptoms as covariates.RESULTS: Participants receiving the MwMs or PJM demonstrated a great-er decrease in VAS scores at rest, activity and night compared to those in the electrotherapy group from baseline to after the treatment (P<.05). This improvement continued at the 1-year follow-up (P<.05). The MwMs and PJM groups also showed significantly improved knee ROM, quad-riceps muscle strength, and WOMAC and ALF scores from baseline to 1-year follow-up (P<.05).CONCLUSIONS: In the treatment of patients with knee OA, either MwMs or PJM in addition to exercise therapy is better than electrotherapy and exercise in terms of pain level, knee ROM, quadriceps muscle strength and functional level. Future longitudinal studies with larger sample siz-es are required to confirm which treatment is most effective in manag-ing knee OA.CLINICAL RELEVANCE: In patients with knee OA, adding either MwMs or PJM to a program of treatment carried out over 12 sessions may lead to a short-term improvement in pain. The beneficial effects on level of func-tion, pain, ROM and muscle strength remain evident 1 year later.

OPO115CAN THE AMOUNT OF EXERCISE IMPACT OUTCOMES IN THE PRESENCE OF SHOULDER PAIN?Michael Kayajanian, Lee N. MarinkoBoston University, Boston, MassachusettsPURPOSE/HYPOTHESIS: Shoulder pain is the third most common muscu-loskeletal condition requiring medical attention. Current evidence sup-ports the use of exercise for painful shoulder conditions; however, there is limited research related to the impact of dosing exercise and outcomes. This study was designed to investigate whether higher volumes of exercise prescribed for patients with shoulder injuries results in greater improve-ments in functional and pain-based outcome measures.NUMBER OF SUBJECTS: Three hundred forty-nine.MATERIALS/METHODS: Retrospective analysis of patient data using diag-nostic codes for nonsurgical shoulder pathology was accessed through an electronic medical record. Records that included 2 separate measure-ments for the outcomes on QuickDASH and numeric pain-rating scale (NPRS) were identified. Records were then accessed to calculate volume of exercises performed. Patients were categorized into 1 of 3 groups, high, moderate, and low with each group further divided into success or fail-

Joseph P. Coviello, Jeannina DeStefano, Jenna Marchinetti, Karli Spencer, Hilary B. GreenbergerPhysical Therapy, Ithaca College, Ithaca, New YorkPURPOSE/HYPOTHESIS: Patellofemoral Pain Syndrome (PFPS) is a frequent-ly encountered musculoskeletal disorder characterized by retropatellar knee pain that worsens with activity. The multifactorial etiology of PFPS alters lower extremity mechanics, increasing PF joint stresses during weight-bearing tasks. Kinesio (KT) and McConnell (MC) tapings are of-ten incorporated into PFPS treatment, but their efficacy is still unclear. Purpose: To test the efficacy of KT, MC and sham taping (ST) in improv-ing knee mechanics and reducing pain during activity. Hypothesis: KT will show better results than MC and ST, given the corrective and facili-tative properties of KT.NUMBER OF SUBJECTS: Ten participants (mean ± SD age, 20.3 ± 1.5 years; height, 169.9 ± 10.4 cm; weight, 70.17 ± 13.1 kg) with anterior knee pain and no history of trauma.MATERIALS/METHODS: Three trials each of squat, drop jump, and step-down tasks with no tape (baseline) and under 3 taping conditions in a random-ized order were performed. Two-dimensional motion analysis of lower ex-tremities in frontal and sagittal planes was performed using 3 iPads and Sparkmotion app. RM univariate ANOVA (P<.05) compared baseline and taping conditions during exercises for pain VAS and knee flexion in all ex-ercises, hip abduction in step-down and drop jump, frontal plane projec-tion in step-downs and anterior knee translation in squat.RESULTS: Significant reductions in VAS were recorded during squats be-tween tapes (F2.505,12.867 = 3.407, P = .042). Pairwise comparison showed a mean decrease in VAS for ST (1.14, P = .008) and KT (1.54, P = .018) com-pared to baseline during squats. Anterior knee translation reduced with KT when compared to baseline during squats (1.92 cm, P = .048). A ten-dency for significance (P = .05-.10) was observed for MC with 1.7° greater reduction in hip abduction in step-down compared to KT (SE, 0.83; P = .075). ST also showed tendency to achieve 6.1° greater knee flexion com-pared to baseline during drop jump (SE, 2.98; P = .073). No other differ-ences were observed (P = .11-.949).CONCLUSIONS: Findings demonstrate mixed results between various tap-ings, including detectable changes with ST similar to previous reports. The effect of tape on pathomechanics is unclear. Sensory effects associat-ed with short term taping may have been sufficient enough to modify knee pain by afferent input blocking nociceptive pain, before the participants could adapt. The role of KT in decreasing anterior knee translation and increasing knee flexion more than other tapings during squats and drop jumps, respectively, may be due to more effective proprioceptive input or neuromuscular facilitation. Minimal changes observed in MC may be due to inferiorly shifted patella leading to increased patellofemoral contact area, allowing for improved knee mechanics.CLINICAL RELEVANCE: A variety of taping methods can potentially reduce perceived pain in individuals with PFPS, allowing clinicians to better tar-get underlying pathomechanics with greater patient satisfaction. Further research is needed to examine the efficacy of patellar taping in correcting pathomechanics and serving as a placebo on perceived pain.

OPO114LONG-TERM CLINICAL OUTCOMES OF 3 DIFFERENT TREATMENT PROGRAMS IN THE MANAGEMENT OF KNEE OSTEOARTHRITIS: A RANDOMIZED CLINICAL TRIALEbru Kaya Mutlu, Ersin Ersin, Arzu Razak Ozdincler, Nadir OnesDivision of Physiotherapy and Rehabilitation, Istanbul University, Faculty of Health Sciences, Istanbul, Turkey; Department of Orthopedics and Traumatology, Bakirkoy; Training and Research Hospital, Istanbul, TurkeyPURPOSE/HYPOTHESIS: Manual therapy is beneficial in the management of knee osteoarthritis (OA), but whether this technique or electrotherapy is superior in knee OA is unclear from the current evidence. The aim of the


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IMPORTANCE TO MEMBERS: This platform is designed to demonstrate devel-opment of continuing education efforts for PT treatment of postconcus-sion patients to a minimum level of competency for this growing patient population in our health system, as well as ongoing team development and innovation.

OPO117SUBCHONDRAL INSUFFICIENCY FRACTURE OF THE FEMORAL HEAD IN A 59-YEAR-OLD WOMAN: A CASE STUDYJoshua R. Kniss, Brian A. Young, Elizabeth Painter, Teddy E. OrtizPhysical Therapy, US Army-Baylor University, Converse, TexasBACKGROUND AND PURPOSE: Subchondral insufficiency fracture (SIF) occurs when normal, physiological stress is applied to weakened or nutritional-ly deficient bone. SIF is most often observed in the hips of osteoporot-ic women or renal transplant recipients. Painful hip flexion and internal rotation are the most common clinical signs, but diagnosis is made from positive MRI findings. This case study highlights the use of diagnostic im-aging and clinical reasoning in the diagnosis and medical management of a patient with SIF of the hip.CASE DESCRIPTION: A 59-year-old woman presented to physical therapy with constant right anterior hip and thigh pain of insidious onset. Initial objec-tive exam findings included: markedly antalgic gait with reluctance to bear weight through the right lower extremity, need for assistance with trans-fers and activities of daily living, pain limited hip flexion to 45°, pain limit-ed internal rotation to 0°, right leg 1 cm shorter than left, and positive pain provocation tests (scour, FABER, log roll). The patient had a past history of thyroid cancer. Following evaluation, the leading differential diagnosis was primary hip osteoarthritis (OA) and physical therapy treatment was initi-ated, consisting of gait normalization, hip range of motion, hip strengthen-ing, and functional movement training. The physical therapist also ordered conventional radiographs to evaluate for more sinister pathology, such as fracture or metastatic cancer, due to symptom severity beyond that expect-ed for hip OA. The patient completed the radiographs 2 weeks after the ini-tial evaluation, which revealed severe joint space narrowing with potential for SIF, avascular necrosis of the femoral head, or blastic metastatic dis-ease. Subsequent MRI revealed SIF of the femoral head and acetabulum, severe OA, and a degenerative tear of the acetabular labrum. The patient was placed on axillary crutches, instructed on toe touch weight bearing, and referred to orthopaedics for further management.OUTCOMES: Prior to orthopaedics referral, the patient received 3 weeks of physical therapy treatment. The patient’s gait was normalized with the use of an assistive device, right hip flexion improved to 90°, and her LEFS score improved from 20/80 to 32/80 over the course of treatment. Due to persistent pain and functional limitations, the patient elected to undergo total hip arthroplasty (THA). Two weeks post THA, the patient report-ed 0/10 resting pain, demonstrated 120° of active hip flexion and 20° ac-tive internal rotation, had returned to work, and re-initiated outpatient physical therapy.DISCUSSION: This case study supports that physical therapists are compe-tent and effective in identifying and managing musculoskeletal condi-tions that require diagnostic imaging. The choice of diagnostic imaging was supported by patient history and clinical exam, and resulted in rapid definitive management. Furthermore, physical therapy treatment helped restore the patient’s quality of life through improved gait and hip mobil-ity while the patient underwent imaging.REFERENCES: Iwasaki K, Yamamoto T, Motomura G, et al. Prognostic fac-tors associated with a subchondral insufficiency fracture of the femoral head. Br J Radiol. 2012;85:214-218. Yamamoto T. Subchondral insuffi-ciency fractures of the femoral head. Clin Orthop Surg. 2012;4:173-180. Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis. 2008;67:150-153. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop

ure based upon the minimal clinically important difference (MCID) out-comes. Effect of exercise volume on outcomes was determined using a multivariate analysis of variance with a least significant difference (LSD) used in post hoc analyses.RESULTS: A total of 194 records were included for QuickDASH and 202 for the NPRS scores. The between group analysis of variance for exercise group to QuickDASH change was significant (P<.001) as well as for meet-ing the MCID (P = .001). Post hoc analysis demonstrated QuickDASH change between the high volume group and the moderate and low volume groups were both significant (P<.001). Between group analysis of variance for group difference in NPRS change was significant (P = .013), but not for meeting the MCID (P = .469).CONCLUSIONS: These results suggest that dosing exercise with a high vol-ume may positively influence outcomes reported on the QuickDASH but not on the NPRS.CLINICAL RELEVANCE: Higher volume exercise prescriptions for shoulder-based injuries may maximize functional improvements.

OPO116INNOVATIVE EDUCATIONAL PRACTICES FOR PHYSICAL THERAPISTS IN THE DEVELOPMENT OF A COMPREHENSIVE SPORTS CONCUSSION CLINIC IN THE UNIVERSITY OF MICHIGAN HEALTH SYSTEMPamela S. KnickerbockerPhysical Therapy Division of Physical Medicine and Rehabilitation, University of Michigan Health System, South Lyon, MichiganPURPOSE: Describe an educational strategy to bring a wider cohort of phys-ical therapists in the University of Michigan Health System to a minimum level of competence for delivering physical therapy care in the NeuroSport Clinic and additional outpatient clinics throughout the system to the post-concussion population.DESCRIPTION: Sport concussions are a growing health concern. The CDC estimates more than 170 000 children and teens are treated in the Emergency Department annually for sports related concussion. It is un-known how many additional athletes self-manage or seek care from a nonconcussion specialist. The primary symptoms after concussion are headache, neck pain, dizziness and balance difficulties. These are all di-agnoses routinely seen by Physical Therapists for treatment. Neurologists from the UMHS NeuroSport Clinic expressed the need for increased access to physical therapy services for their postconcussion patients. It was decided to provide a continuing education course for UMHS physi-cal therapists to gain both didactic and clinical skills for improved com-prehensive treatment of the postconcussion patient. Content areas were identified and content experts were surveyed to determine the minimum competencies for these clinical problems in the context of sport concus-sion. Content areas identified were: manual therapy for cervical spine, vestibular/balance issues, cranial mobility, TMJ and exertional testing. Content experts identified minimum clinical competencies for lab in-struction and check off. A total of 49 individuals participated. Thirty-eight physical therapists (including 9 presenters and lab assistants), 5 physicians, 1 Occupational Therapist presenter, 4 ATCs and 1 academ-ic PT faculty/researcher participated. As part of the development of the course new home exercises were developed and existing home exercises were revised and updated. A post course survey was conducted. Nineteen participants responded (excluding presenters and lab assistants). Among the results of the survey, 14 responded “definitely yes” and 4 responded “probably yes” to the question “Would you recommend this course to oth-ers?” Survey results also illuminated areas of improvement on the course for future offerings.SUMMARY OF USE: For this platform, topics and competencies performed from the course “PT Management of the Post-Concussion Patient” will be presented as well as samples of home exercises developed for this popula-tion. Postcourse survey results will be presented as well as suggestions for modifications for future course presentations.


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Physiol Ther. 2009;32:203-209 5. Van Hoof W, Volkaerts K, O’Sullivan K, Verschueren S, Dankaerts W. Comparing lower lumbar kinematics in cyclists with low back pain (flexion pattern) versus asymptomatic con-trols--field study using a wireless posture monitoring system. Man Ther. 2012;17:312-317.

OPO119ABNORMAL IMAGING FINDINGS IN ASYMPTOMATIC SHOULDERS: A SYSTEMATIC LITERATURE REVIEWEric L. Koehler, Robert Boyles, Daniel Rhon, Ben R. HandoPhysical Therapy, University of Puget Sound, Tacoma, Washington; Evidence in Motion, Louisville, Kentucky; Graduate Program in Physical Therapy, Baylor University, San Antonio, Texas; Physical Therapy, US Air Force, San Antonio, TexasPURPOSE/HYPOTHESIS: Diagnostic imaging is frequently utilized as part of a comprehensive exam for patients with shoulder complaints. However, previous studies have found high rates of pathological findings in asymp-tomatic individuals [1]. This phenomenon has been reported extensive-ly in the lumbar spine [2], but to a lesser degree in the shoulder [3]. The purpose of this study is to systematically review the literature and re-port the pooled prevalence of abnormal imaging findings in asymptom-atic shoulders.NUMBER OF SUBJECTS: Four thousand three hundred three asymptomat-ic shoulders.MATERIALS/METHODS: An online search was performed using PubMed and Google Scholar for studies through December 2015. Search terms includ-ed keywords such as, “shoulder” or “rotator cuff” or “glenohumeral” or “glenoid labrum” or “AC joint” or “sternoclavicular joint” or “biceps ten-don”, AND “X-ray” or “imaging” or “MRI” or “ultrasound” AND “inciden-tal” or “asymptomatic.” Studies where included if authors reported the specific number of unique shoulders with abnormal findings in symptom-atic versus asymptomatic patients, or only in asymptomatic patients. In either case, only asymptomatic subjects were extracted and used in our analysis. This search yielded 261 abstracts that where reviewed for rele-vance, of which 29 studies met the criteria for inclusion.RESULTS: The search yielded 4303 asymptomatic shoulders from 3768 hu-man subjects. Both athletic and nonathletic populations were represent-ed with ages ranging from 13 to 90 years. In studies that reported age and sex, the weighted mean age was 54 years, and 45.5% were males. The prevalence of abnormal findings in shoulders ranged widely. On the low-er end, 7% of asymptomatic subjects had evidence of full thickness ro-tator cuff tear on ultrasound [4]. On the higher end, 100% of asymp-tomatic subjects had minor abnormalities in both the supraspinatus and infraspinatus tendons with MRI [5]. In most studies (19/29), abnormal findings equaled, or exceeded 50% of subjects. Common abnormal find-ings were found in the articular, peri-articular and musculotendinous tis-sues. Common articular abnormalities in asymptomatic shoulders includ-ed subchondral cysts, osteophytes, joint erosion, labrum tears, capsular distention, irregular margins, and joint hypertrophy. Abnormal peri-ar-ticular joint findings ranged from bursal thickening to impingement. Abnormal musculotendinous findings included partial-thickness tears, full-thickness tears, and tendinopathy.CONCLUSIONS: Asymptomatic shoulders have a high prevalence of patho-logical findings.CLINICAL RELEVANCE: With a high rate of abnormal findings in asymptom-atic shoulders, clinicians should interpret findings in symptomatic pa-tients with caution. This underscores the importance of interpreting results from imaging studies in the context of a detailed clinical exam-ination. Clinicians can also incorporate this information into their pa-tient education.

OPO120MCKENZIE APPROACH IN MANAGEMENT OF A WOMAN WITH CHRONIC SHOULDER PAIN: A CASE STUDY

Surg. 2014;22:455-464. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D, Greenwald R, Hochberg M, Howell D, Ike R, Kapila P, Kaplan D, Koopman W, Marino C, McDonald E, McShane DJ, Medsger T, Michel B, Murphy WA, Osial T, Ramsey-Goldman R, Rothschild B, Wolfe F. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505-5514. Childs JD, Whitman JM, Sizer PS, et al. A description of physi-cal therapist’s knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord. 2005;6:32.

OPO118USE OF THORACIC MANUAL THERAPY IN THE SUCCESSFUL MANAGEMENT OF A PROFESSIONAL CYCLIST WITH NEURAL MECHANOSENSITIVITY IMPAIRING POWER OUTPUT: A CASE REPORTStacey Knowles, Christine Schauerte, Darren EarnshawRush University Medical Center, Chicago, IllinoisBACKGROUND AND PURPOSE: Thoracolumbar pain is the most common com-plaint that leads professional cyclists to seek medical attention, and may lead to an inability to maintain efficient postures and generate power. Sustained thoracolumbar flexion during cycling loads the posterior spi-nal, neural and musculoskeletal structures potentially increasing neural mechanosensitivity (NMS). Utilization of the Thoracic Slump Test (TST), which closely mimics the cyclist’s posture, has not been studied in this population. The purpose of this case report is to describe the utilization of TST and manual therapy, specifically thoracic and hip joint mobilization and neural mobilization, in the successful management of an elite cyclist with pain, reduced power output and NMS.CASE DESCRIPTION: A 49-year-old female professional cyclist with no signif-icant past medical history presented to physical therapy (PT) with left an-terior hip pain, left lower thoracic pain and complaint of decreased power output for 2 months during her transition from indoor to outdoor track and criterion cycling. Stretching, rest and bike component modification previously alleviated pain however symptoms had worsened with cycling greater than 20 minutes, sprints and uphill climbing. Significant evalua-tion findings included pain, decreased thoracic extension and left hip flex-ion AROM, thoracic spine hypomobility with passive accessory mobility testing and limited left TKE during TST. She was treated with hip mobili-zations, thoracic thrust/nonthrust mobilizations, therapeutic exercise and neural mobilization in TST position.OUTCOMES: She was seen in PT for 6 sessions over 8 weeks. The numer-ic pain-rating scale scores improved from 8/10 to 2/10, global rating of change +2 to +7, Patient Specific Functional Scale from 6 to 8, TKE in TST position improved from –75° TKE to 0°, and her L hip flexion AROM improved from 120° to 140°. Power output improved from 250 W/kg to 287 W/kg.DISCUSSION: Utilization of the TST, which mimics the cyclist’s posture and reproduced the concordant pain, guided the decision to use neural mobi-lization and thoracic manual therapy in the treatment. NMS may lessen force generation if the cyclist is not able to assume efficient cycling pos-tures and achieve full TKE during the power phase of the pedal stroke. This case study suggests the potential importance of the TST in the eval-uation of cyclists and the role of manual therapy in efficiently resolving thoracolumbar pain and impaired power output.REFERENCES: 1. Andrade RJ, Freitas SR, Vaz JR, Bruno PM, Pezarat-Correia P. Provocative mechanical tests of the peripheral nervous system affect the joint torque-angle during passive knee motion. Scand J Med Sci Sports. 2015;25:338-345 2. Clarsen B, Krosshaug T, Bahr R. Overuse injuries in professional road cyclists. Am J Sports Med. 2010;38:2494-2501]. 3. Joshi KC, Eapen C, Kumar SP. Normal sensory and range of motion (ROM) responses during thoracic slump test (ST) in asymptom-atic subjects. J Man Manip Ther. 2013;21:24-32 4. Lalanne K, Lafond D, Descarreaux M. Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study. J Manipulative


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MacDermid JC, Solomon P, Prkachin K. The shoulder pain and disabil-ity index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord. 2006 7:12. 9. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol. 2004;33:73-81. 10. McKenzie RA, May S. The Lumbar Spine: Mechanical Diagnosis and Therapy. 2nd ed. Waikanae, New Zealand: Spinal Publications; 2003. 11. Aina A, May S: Case report - a shoulder de-rangement. Man Ther. 2005.

OPO121EFFECTS OF MULTIDIRECTIONAL GASTROCNEMIUS-SOLEUS STRETCHING VERSUS STATIC GASTROCNEMIUS-SOLEUS STRETCHING ON CLOSED-CHAIN DORSIFLEXIONKimberly Kruchowsky, Thomas Land, Blake K. McDonald, Christopher Melcher, Derrick TalleyPhysical Therapy, Franklin Pierce University, Rindge, New HampshirePURPOSE/HYPOTHESIS: Limited ankle dorsiflexion (DF) ROM has been linked to risk factors related to lower extremity injuries. The purpose of this study was to determine if ankle DF improved when the gastrocne-mius-soleus (GS) complex was stretched via a dynamic multidirectional maneuver involving hip and knee drivers when compared to a static GS stretch alone.NUMBER OF SUBJECTS: Twenty-eight physical therapy students (12 male, 16 female) with mean ± SD age of 26.04 ± 5.07 years voluntarily consented for participation in this convenience sample study.MATERIALS/METHODS: Performance of static and multidirectional GS stretches was accomplished with subjects standing barefoot on a slant board. A standardized script was used to describe the desired stretch-ing maneuvers. Verbal cuing was employed as needed to facilitate proper foot positioning and performance of both the static and multidirectional stretches. Subjects were first randomly allocated to either static or mul-tidirectional stretch via random card selection. Pre– and post–weight-bearing ankle DF measurements were then obtained using the distance-to-wall technique with attained values acquired in cm. Two replicated measurement stations were used with an ICC calculated to ensure inter-rater consistency. ANOVA was used to assess within and between group differences; significance was set at α = .05. Repeated-measures ANOVA was employed to assess pairwise differences. Bonferroni adjustment was provided for all repeated measure comparisons. Version 23 SPSS software was utilized for data analyses.RESULTS: No significant difference was found between dynamic and static stretching (P = .86). There was, however, significant improvement from the baseline measurement for both static and dynamic stretches (P≤.05). Mean ± SD measures for baseline, static, and dynamic maneuvers were: 10.0 ± 3.7, 11.1 ± 3.5, 11.2 ± 3.5, respectively.CONCLUSIONS: Multidirectional dynamic stretching produced no signif-icant increase in knee-to-wall distance compared to static stretching. However, a significant difference was noted between baseline and both static and dynamic stretching.CLINICAL RELEVANCE: When improved ankle DF is a treatment goal, patients can benefit from performing either a dynamic multiplanar stretch or a static stretch. However, the movements associated with a dynamic stretch can benefit the body as a whole. Future considerations for improving per-formance of ankle DF ROM point to the value of incorporating a struc-tured dynamic warm-up prior to obtaining ROM measurements.

OPO122EFFECTS OF A VARIABLE VIBRATION BRACE ON PROPRIOCEPTION IN ACUTE ANKLE SPRAINS POSTIMMOBILIZATION: A PILOT STUDYJeff Kunze, Adam Moore, Collin McDonell, Mark Huntsinger, Rebecca Araki, Jana Sadler, Ryan Yoshida, Courtney Peterson, Aimie KachingweCORE Physical Therapy, Huntington Beach, California; Torrey

McKenzie M. Kraus, A. Russell Smith, Scott BossmanLynchburg College, Lynchburg, VirginiaBACKGROUND AND PURPOSE: Diagnosing shoulder disorders is challenging given the moderate reliability/validity of shoulder special tests. Incidental imaging findings of rotator cuff pathology in 65% of asymptomatic indi-viduals complicates the identification of a specific pathoanatomical struc-ture. Mechanical Diagnosis and Therapy (MDT) focuses primarily on pa-tient response to movement. McKenzie proposed the method could also be applied to the peripheral joints. The approach to the extremities also utilizes the patient’s response to repeated movements and loading strate-gies, as opposed to the identification of a pathoanatomical structure with classification of a patient into 1 of 3 categories: derangement, dysfunc-tion, or postural syndrome. The purpose of this case report is to describe the application of the Mechanical Diagnosis and Treatment approach to the assessment and management of a patient with nonspecific, chronic shoulder pain.CASE DESCRIPTION: A 66-year-old woman presented reporting generalized left shoulder pain. MRI findings included a partial supraspinatus tear, acromioclavicular arthritis, and biceps tendinitis. Applying elements of the International Classification of Functioning (WHO), functional loss-es related to inability to play with her grandchildren and perform activi-ties of daily living (ADLs) were noted. The Shoulder Pain and Disability Index (SPADI) initially indicated an 81% perceived disability. Physical ex-amination focused on the left shoulder with standard movement screen followed by repeated movement testing (RMT), a key component of the MDT physical examination. Behind-the-back movements were particu-larly limited and painful. During RMT, the patient’s range improved with decreased pain. Repeated external rotation provoked symptoms and re-duced ROM. Education for self-management included instructed on en-forcing repeated movement in the direction of preference with over pres-sure and avoidance of provocative. Further treatments continued to emphasize repeated movements with addition of functional strengthen-ing exercises related to her functional losses.OUTCOMES: Abolishment of pain with ADLs and functional tasks were not-ed at the fifth and final visit with an improved SPADI score (5% perceived disability). Via telephone 3 weeks following discharge, the patient report-ed continued pain abolishment with full pain free movement. Additional follow-up was conducted 3 months after discharge with a SPADI score of 0.01%.DISCUSSION: Despite chronicity and high pain intensity, she demonstrat-ed significantly decreased pain and simultaneous improvement in mo-tion, strength, and function within 5 visits. Improved SPADI scores were significantly greater than the minimal clinically important difference [8]. Actively involved in self-managing her own symptoms, this treatment ap-proach was effective and economical. The patient’s improvement contin-ued to be evident 3 months after discharge.REFERENCES: 1. Hegedus EJ, Goode A, Campbell S, et al. Physical examina-tion tests of the shoulder: a systematic review with meta-analysis of indi-vidual tests. Br J Sports Med. 2008;42:80-92; discussion 92. 2. Tennent TD, Beach WR, Meyers JF. A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests. Am J Sports Med. 2003;31:154-160. 3. May S, Chance-Larsen K, Littlewood C, Lomas D, Saad M. Reliability of physical examination tests used in the assessment of patient with shoulder problems: a systematic review. Physiotherapy.. 2010;96:179-190. 4. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19:116-120. 5. McKenzie R, May S. The Human Extremities Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal Publications; 2000. 6. May S. Classification by McKenzie’s mechanical syndromes; report on directional preference and extremity patients. Int J Mech Diag Ther. 2006;1:3,7-11. 7. May S, Ross J. The McKenzie classification system in the extremities: a reliability study using McKenzie assessment forms and ex-perienced clinicians. J Manipulative Physiol Ther. 2009;32:556-563. 8.


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NUMBER OF SUBJECTS: Seven included randomized clinical trials that satis-fied eligibility requirements.MATERIALS/METHODS: The following databases were searched using the terms Instrument Assisted Soft Tissue, Pain, Function, Graston, and soft tissue mobilization: CINAHL, PubMed, and Academic Search Complete. Criteria for inclusion in this review were: studies on patients with mus-culoskeletal impairments, studies needed to include soft tissue mobiliza-tion as a treatment intervention, studies had to be a randomized clinical trial, studies were performed on human subjects, and studies had to cap-ture a measure of pain or function. Criteria for exclusion in this review were: studies not published in English or if the subjects in the study were of the pediatric or geriatric populations. Included articles were appraised using the PEDro scale.RESULTS: Seven studies met the inclusion criteria. All 7 articles scored be-tween a 4/10 and 7/10 on the PEDro scale. The articles that met the in-clusion criteria involved treatment of numerous anatomical locations and the majority of the studies demonstrated significant improvements in ei-ther pain and/or range of motion, or exceeded the minimal clinically im-portant difference of a standardized functional outcome measure when using IASTM compared to control or conservative treatment groups.CONCLUSIONS: These outcomes suggest that IASTM can have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and im-provement of flexibility of underlying tissue compared to other common-ly utilized interventions.CLINICAL RELEVANCE: The results of the studies included in this review suggest that IASTM is an effective treatment intervention for reducing pain and improving range of motion and/or function within a 3-month follow-up.

OPO124USING MEASURES OF CENTER OF MASS ESTIMATED AND CENTER OF PRESSURE DURING GAIT IN THE DESIGN OF A ROCKER-SOLE MODIFICATION FOR AN INDIVIDUAL WITH FUNCTIONAL ANKLE MOBILITY LIMITATIONSteve Laslovich, Anna M. EdwardsPhysical Therapy, University of St Augustine, San Marcos, CaliforniaBACKGROUND AND PURPOSE: Instrumented walkway assessment can be used to allow dynamic simultaneous quantification of center of mass estimated (COMe) and center of pressure (COP) relationships during normal, slow, and fast gait. The purpose of this case report is to demonstrate the suc-cessful utilization of dynamic measures of COMe with simultaneous mea-surement of COP during gait in the design of shoe modification to pro-mote ankle and forefoot rocker function in an individual with severe loss of functional sagittal plane ankle mobility.CASE DESCRIPTION: The patient was a 32-year-old man who suffered a TBI in a MVA with multiple lower extremity injuries including severe bilateral distal tibia and fibula fractures. At 18 months postinjury, ankle doriflexion remained severely limited with significant ankle joint pain. Joint mobility assessment suggested limited potential to regain functional dorsiflexion ROM. Self-selected gait velocity measured over repeated trials 0.67 m/s. Instrumented walkway analysis showed both a delay and abnormal rela-tionship between COMe and COP forward progression during early mid through terminal stance. Based on the COMe and COP measures, shoe modifications were fabricated consisting of a right sole based rocker lo-cated 1 cm forwards of the anterior lateral malleolus with an approximate 5 cm radius. Additionally, moderately aggressive rigid toe spring modifi-cations were done bilaterally.OUTCOMES: Following the shoe modification and gait training, velocity of the forward progression of the COP, initially slowed during early stance, phase improved to 1.18 m/s. Forward progression velocity of the COMe, significantly delayed initially also improved in concert with the COP pro-gression. Simultaneously, subjective complaints of ankle pain decreased

Pines Orthopedic Medical Group, San Diego, California; George Erb Physical Therapy, Camarillo, California; Daily Thera-Stretch Physical Therapy, Los Angeles, California; Doctorate of Physical Therapy Program, California State University Northridge, Northridge, CaliforniaPURPOSE/HYPOTHESIS: Lateral ankle sprains account for 25% of all muscu-loskeletal injuries, are the single most prevalent sports-related injury, and have a 70% recurrence rate [1-3]. Ankle sprains are typically treated with immobilization, leading to significant proprioceptive deficits [1]. Ankle sprains often result in chronic ankle instability due to ligamentous lax-ity, proprioceptive deficits, and/or functional ankle instability (FAI) “the subject’s perception that the ankle is unstable, weaker, more painful, or less functional following injury [3]. The purpose of this study was to in-vestigate the effects of applying variable vibrations via an external vibra-tion-inducing device to an immobilized ankle joint after sustaining an acute ankle sprain. Vibrations are theorized to improve FAI by prevent-ing the loss of proprioceptive input from the joint via activation of muscle spindles and mechanoreceptors typically impaired during immobilization [4]. We hypothesized that applying variable frequency and amplitude vi-brations with a vibration AFO would produce significant improvements in outcome measures evaluating postimmobilization kinesthesia (Joint Position Sense [JPS]), proprioceptive input (Sensory Organization Test [SOT]), and ankle function (Motor Control Test [MCT]), Unilateral Stance (US), STAR Excursion Balance Test (SEBT), Foot and Ankle Disability Index [FAD]]) as compared to standard immobilization with-out vibration.NUMBER OF SUBJECTS: Ten.MATERIALS/METHODS: Ten subjects presenting to a university student health center with a grade II-III lateral ankle sprain were randomly allocated into 2 groups. Control subjects were immobilized with a standard ankle foot orthosis (AFO). Experimental subjects were immobilized with a spe-cially designed vibration AFO. Motors were placed at 5 tendons surround-ing the ankle to create illusory movement [5] and controlled by a circuit board set to perform vibrations at 50 to 100 Hz for a cumulative time of 45 minutes per day. Subjects were evaluated after 7 days of immobiliza-tion by testers blinded to group assignment.RESULTS: Within-subject statistically significant differences were found for MCT amplitude scaling with backward translation (P = .038) and for SEBT in the posteromedial direction (P = .038). Between-subject differ-ences were found for SOT condition 1 (P = .019) and FADI (P = .010). Statistical significance (P<.05) was not detected for the other outcome measures, although they trended in support of vibration for reduced pro-prioceptive loss.CONCLUSIONS: Applying variable vibrations via an external vibration-in-ducing device to an immobilized ankle joint following an acute lateral ankle sprain showed limited support for preventing proprioceptive loss.CLINICAL RELEVANCE: There is some evidence suggesting that individuals receiving vibration during immobilization post ankle sprain had less pro-prioceptive loss. This may result in returning to previous level of func-tion more quickly and fewer recurring ankle sprains compared to stan-dard immobilization.

OPO123THE EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION COMPARED TO OTHER INTERVENTIONS ON PAIN AND FUNCTION: A SYSTEMATIC REVIEWMatthew D. Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ V. Morazzini, Amber L. Wallace, Dakota Conroy, Joshua ClelandFranklin Pierce University, Manchester, New HampshirePURPOSE/HYPOTHESIS: To systematically examine evidence on the effective-ness of instrument assisted soft tissue mobilization (IASTM), compared to other manual therapy interventions on patients with pain and disabil-ity resulting from musculoskeletal impairments.


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Rutkowska-Kucharska A. Estimated ground reaction force in normal and pathological gait. Acta Bioeng Biomech. 2009;11:53-60.

OPO125TELEREHABILITATION IMPROVES QUALITY OF LIFE, REDUCES DISABILITY, AND IS ASSOCIATED WITH PATIENT SATISFACTION AFTER TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW OF THE LITERATUREDanika LeBlanc, Courtney Summers, Paula Smith, Nancy A. Bianchi, Reuben S. EscorpizoDepartment of Rehabilitation and Movement Science, Doctor of Physical Therapy Program, University of Vermont, Burlington, Vermont; Dana Medical Library, University of Vermont, Burlington, VermontPURPOSE/HYPOTHESIS: Total knee arthroplasty (TKA) is a common surgery requiring postsurgical rehabilitation to improve outcomes in function. Telerehabilitation is a feasible alternative approach to face-to-face out-patient and home care in delivering health care services in rural settings where demand is high and access is limited. The benefits of telerehabil-itation in TKA have been less thoroughly analyzed. The purpose of this review is to compare conventional face-to-face therapy and telerehabili-tation in terms of therapeutic outcomes, patient satisfaction, and cost ef-fectiveness for post-TKA patients.NUMBER OF SUBJECTS: Six studies were included in this systematic litera-ture review.MATERIALS/METHODS: Four electronic databases were searched: Cochrane Library, Ovid MEDLINE, CINAHL, and PEDro. Studies were consid-ered for inclusion if physical therapy was implemented via telerehabili-tation for postoperative TKA patients. Outcomes had to address thera-peutic outcomes, patient satisfaction, or cost effectiveness. Two reviewers extracted study and participant characteristics. Quality and level of ev-idence were assessed using the PEDro scale and OCEBM levels of evi-dence. Action statements were generated and assigned an OCEBM grade of recommendation.RESULTS: The review included 6 RCTs providing 731 participants. There was Grade B evidence for action statements related to improving qual-ity of life, reducing disability, and maintaining patient satisfaction. Improving functional activity was also supported by grade B evidence, however, based on a preponderance rather than consistent evidence. Due to insufficient evidence pertaining to cost-effectiveness we were unable to form an action statement.CONCLUSIONS: This review identified moderate evidence to support that telerehabilitation can be as effective as conventional face-to-face therapy in improving quality of life, reducing disability, and maintaining patient satisfaction post TKA. There is conflicting evidence that telerehabilita-tion is as effective in improving functional activity, though supporting ev-idence outweighs refuting evidence. Despite a lack of supporting studies, cost analyses demonstrated telerehabilitation might be a cost-effective al-ternative to conventional therapy, although further research on econom-ic costing is required.CLINICAL RELEVANCE: Although face-to-face care may be necessary on some occasions for particular patients, the results of this review strongly sug-gest that in-home telerehabilitation could be used to improve accessibil-ity of health care services in rural, remote communities and dense urban locations where high volume, waiting times, and cost of services are major barriers to people who have undergone a TKA procedure.

OPO126DOES SLEEP QUALITY MODERATE THE RELATIONSHIP BETWEEN PAIN INTENSITY AND HEALTH CARE UTILIZATION? LONGITUDINAL ANALYSIS FROM A COHORT OF PATIENTS WITH LOW BACK PAINHopin Lee, Daniel Rhon, Vincent Mysliwiec, Edel O’HaganBody in Mind Research Group, Neuroscience Research Australia, Sydney, Australia; Sleep Medicine Fellowship, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas;

progressively over the proceeding weeks leading to self-measured daily ambulation bouts of up to 3 mi.DISCUSSION: Clinical decision-making skills of a physical therapist in cas-es of chronic dysfunction leading to significant impairments in gait can be aided by the use of emerging technologies such as instrumented walk-ways. This case demonstrates the ability to utilize quantitative measures of COMe and COP during gait as a potential tool to guide external shoe modification designs in an individual with chronic painful loss of ankle dorsiflexion motion limiting gait. Shoe modifications such as rocker soles, while not new to physical therapy, can be effective when designed target-ing a specific gait impairment. The relationships in biomechanical mea-sures such as COP and COM dynamics during gait do not lend themselves easily to visual observation even in the experienced therapist. This case report demonstrates the potential of using measures such as the relation-ship between COM and COP gathered through an instrumented walkway and hopes to stimulate future studies in individuals with gait dysfunction.REFERENCES: 1. Arazpour M, Hutchins SW, Ghomshe FT, Shaky F, Karami MV, Aksenov AY. Effects of the heel-to-toe rocker sole on walking in able-bodied persons. Prosthet Orthot Int. 2013;37:429-435. 2. Bachasson D, Moraux A, Ollivier G, et al. Relationship between muscle impairments, postural stability, and gait parameters assessed with lower-trunk acceler-ometry in myotonic dystrophy type 1. Neuromusc Disord. 2016. 3. Chien HL, Lu TW, Liu MW. Control of the motion of the body’s center of mass in relation to the center of pressure during high-heeled gait. Gait Posture. 2013;38:391-396. 4. Demura T, Demura S, Uchiyama M, Kitabayashi T, Takahashi K. Effect of shoes with rounded soft soles in the anterior-posterior direction on the center of pressure during static standing. Foot (Edinb). 2015;25:97-100. 5. Demura T, Demura S, Yamaji S, Yamada T, Kitabayashi T. Gait characteristics when walking with rounded soft sole shoes. Foot (Edinb). 2012;22:18-23. 6. Fukaya T, Mutsuzaki H, Okubo T, Mori K, Wadano Y. Relationships between the center of pressure and the movements of the ankle and knee joints during the stance phase in patients with severe medial knee osteoarthritis. Knee. 2016. 7. Gard SA, Miff SC, Kuo AD. Comparison of kinematic and kinetic methods for com-puting the vertical motion of the body center of mass during walking. Hum Mov Sci. 2004;22:597-610. 8. Gutierrez-Farewik EM, Bartonek A, Saraste H. Comparison and evaluation of 2 common methods to measure center of mass displacement in 3 dimensions during gait. Hum Mov Sci. 2006;25:238-256. 9. Hong SW, Leu TH, Wang TM, Li JD, Ho WP, Lu TW. Control of body’s center of mass motion relative to center of pressure during uphill walking in the elderly. Gait Posture. 2015;42:523-528. 10. Howcroft J, Lemaire ED, Kofman J, Kendell C. Understanding responses to gait instability from plantar pressure measurement and the relation-ship to balance and mobility in lower-limb amputees. Clinical Biomech (Bristol, Avon). 2016;32:241-248. 11. Janisse DJ, Janisse E. Shoe mod-ification and the use of orthoses in the treatment of foot and ankle pa-thology. J Am Acad Orthop Surg. 2008;16:152-158. 12. Long JT, Sirota N, Klein JP, Wertsch JJ, Janisse D, Harris GF. Biomechanics of the dou-ble rocker sole shoe: gait kinematics and kinetics. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2004;7:5107-5110. 13. Luximon Y, Cong Y, Luximon A, Zhang M. Effects of heel base size, walking speed, and slope angle on center of pressure trajectory and plantar pressure when wearing high-heeled shoes. Hum Mov Sci. 2015;41:307-319. 14. Myers KA, Long JT, Klein JP, Wertsch JJ, Janisse D, Harris GF. Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics. Gait Posture. 2006;24:323-330. 15. Simonsen EB. Contributions to the un-derstanding of gait control. Dan Med J. 2014;61:B4823. 16. Van Bogart JJ, Long JT, Klein JP, Wertsch JJ, Janisse DJ, Harris GF. Effects of the toe-only rocker on gait kinematics and kinetics in able-bodied persons. IEEE Trans Neural Syst Rehabil Eng. 2005;13:542-550. 17. Wang CC, Hansen AH. Response of able-bodied persons to changes in shoe rock-er radius during walking: changes in ankle kinematics to maintain a con-sistent roll-over shape. J Biomech. 2010;43:2288-2293. 18. Winiarski S,


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NUMBER OF SUBJECTS: Forty-eight (130 limbs).MATERIALS/METHODS: Forty-eight adults were randomized into 2 groups, TSM or a sham intervention (TSM procedure without a thrust), and test-ed for the presence of neurodynamic limitations via the ULPT and SST. Those who met previously published range of motion limitations (n = 43) for at least 1 of the 4 limbs measured received their preassigned interven-tion (TSM, n = 22; sham, n = 21). Neurodynamic mobility was reassessed after intervention. Subjects were questioned preintervention and postint-ervention regarding perceived effect and to determine believability of the proposed sham manipulation.RESULTS: Forty-three subjects (60 UE and 70 LE) demonstrated posi-tive neurodynamic testing. Separate 2-by-2 repeated-measures analy-ses of variance were used to examine the effects of intervention (TSM, sham) and time (preintervention, postintervention) on ULPT and SST measurements. Both the ULPT (F1,49 = 42.56, P<.001) and SST (F1,59 = 20.50, P<.001) demonstrated improvements at posttest regardless of in-tervention received. ULPT effect size for both TSM (d = 0.75) and sham (d = 0.79) groups were medium. However, for the SST, the effect size for the TSM group (d = 0.60) was medium, while the sham group (d = 0.22) was small. No significant differences were noted for believability of the intervention received (η2 = 3.74, P = .44) or for perception of effect be-tween groups pretreatment (η2 = 2.83, P = .24) and posttreatment (η2 = 2.71, P = .61).CONCLUSIONS: These findings indicate that peripheral neurodynamic mo-bility improved in both the upper and lower quarter regardless of inter-vention. The magnitude of change in lower quarter neurodynamic mo-bility following TSM further supports a neurophysiologic mechanism of manipulation. In addition to proposed neurophysiologic effects supported by previous research, the remaining findings highlight nonspecific effects such as therapeutic alliance and patient expectation that may impact the clinical benefit of manipulation. The sham utilized in this study demon-strated adequacy as a sham comparator to a supine TSM.CLINICAL RELEVANCE: While thoracic spine manipulation has been correlat-ed with improvements in local and peripheral impairments, assessment of patient expectations and beliefs may assist therapists in technique se-lection if improvement in peripheral neurodynamic mobility is sought.

OPO128INTERRATER AND INTRARATER RELIABILITY OF A CORE STABILITY PERFORMANCE TESTKari M. Lindegren, Kristin Bastian, Robyn McHugh, Christopher J. Kovacs, Mark V. PaternoOrthopedic and Sports Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OhioPURPOSE/HYPOTHESIS: The supine double leg lowering test (SDLLT) as ini-tially described by Kendall has been previously reported in the literature as a reliable measure of core activation and stability during lower extrem-ity movement [1]. However, there is wide variability in the execution and measurement of the SDLLT. The purpose of this study was to define a standard method of implementing the SDLLT and to investigate the inter and intrarater reliability of this method. It was hypothesized that examin-ers would demonstrate moderate to good inter and intrarater reliability in their measurement of the SDLLT.NUMBER OF SUBJECTS: Ten healthy subjects (mean ± SD age, 22.5 ± 1.6 years; 6 female, 4 male).MATERIALS/METHODS: Two licensed physical therapists measured and re-corded data for ten subjects who performed 4 trials of the SDLLT with a 1-minute break between each. The physical therapists were trained in performing and measuring the SDLLT using a protocol developed using previous research published in the literature [2,3]. A stabilizer, which was placed under the subject’s lumbar spine, was used to monitor the end of the test. At this end point, 1 examiner used a single inclinometer to re-cord performance in degrees from horizontal. Specific methodology was utilized to eliminate the potential for intrarater bias while measuring the

Graduate Programs in Physical Therapy, Baylor University, San Antonio, TexasPURPOSE/HYPOTHESIS: Pain intensity in patients with back pain is associat-ed with pain related disability and health care utilization. It is also known that these patients have comorbidities that can influence factors like dis-ability and the back pain related health care utilization. One of these co-morbidities is sleep quality. The purpose of this study was to evaluate the relationship between perceptions of daytime sleepiness and patients seek-ing continued care for back pain. Specifically, we wanted to determine whether sleepiness was able to moderate the relationship between pain and health care utilization, and disability and health care utilization.NUMBER OF SUBJECTS: Seven hundred fifty-eight patients referred to self-management education class for low back pain in the physical therapy clinic at Madigan Army Medical Center, Tacoma, WA, between March 1, 2010 and December 4, 2012.MATERIALS/METHODS: Participants completed self-reported measures of pain intensity, disability (Oswestry Disability Index), and sleepiness (Epworth Sleepiness Scale). Healthcare utilization was extracted from the Military Health System Data Repository (MDR) for a 24-month pe-riod (12 months before and after the self-management class). Total num-ber of lumbar spine-related medical visits was abstracted for the 1-year period after the class based on relevant International Classification of Diseases, Ninth Edition (ICD-9) codes. Total number of comorbidities over the 24-month period was also collected for each subject. The asso-ciation between pain intensity and health care utilization (medical visits) was investigated using multivariate Poisson regression analyses, adjusted for previous history of back pain, and the total number of comorbidities. To examine the moderating effect of sleepiness, we tested its interaction with pain intensity. These analyses were repeated with disability as the outcome, using multivariate linear regression.RESULTS: Pain intensity levels were associated with the total number of medical visits (IRR = 1.11; 95% CI: 1.09, 1.13; P<.01) and disability ratings (IRR = 1.03; 95% CI: 1.02, 1.03; P<.01). Sleepiness significantly moder-ated the relationship between disability rating and the number medical visits (IRR = 0.99; 95% CI: 0.99, 0.10; P<.01), but did not moderate the relationship between pain intensity and medical visits (IRR = 0.99; 95% CI: –0.99, 1.00; P = .40).CONCLUSIONS: Higher pain intensity and disability were associated with greater 1-year LBP-related health care utilization. The presence of sleep-iness increased the amount of LBP-related health care utilization in pa-tients with higher disability, but not in patients with higher pain intensity.CLINICAL RELEVANCE: Assessing and addressing sleepiness in patients with low back pain has the potential to assist clinicians in their interpretation of how disability will impact long-term health care utilization.

OPO127THE IMMEDIATE EFFECTS OF THORACIC SPINE MANIPULATION VERSUS A SHAM COMPARATOR ON THE UPPER-LIMB PROVOCATION TEST AND SEATED SLUMP TESTAJ Lievre, Aaron Hartstein, Kristina Clinton, Julia L. Falken-klous, Erika Finn, Reihle Kash, Heather E. Lauth, Robert Nester, Sheri A. HaleDivision of Physical Therapy, Shenandoah University, Winchester, VirginiaPURPOSE/HYPOTHESIS: Previous research suggests that mechanical and neurophysiologic mechanisms may be responsible for the clinical bene-fits of manipulation. While studies indicate remote and peripheral im-provements in pain, range of motion, and motor function following ma-nipulation, no studies have investigated the effects of a supine thoracic spine manipulation (TSM) on neurodynamic mobility, as compared to a sham intervention. This study aimed to determine the immediate effects of TSM on the Upper Limb Provocation Test (ULPT) and Seated Slump Test (SST) compared to a sham intervention in asymptomatic subjects with neurodynamic limitations.


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PE, Glynn P, Cleland JA. Psychometric properties of the Shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire and numeric pain rating scale in patients with shoulder Pain. J Shoulder Elbow Surg. 2009;18:920-926. 4. Strunce JB, Walker MJ, Boyles RE, Young BA. The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. J Man Manip Ther. 2009;17:230-236. 5. Walser RF, Meserve BB, Boucher TR. The effectiveness of tho-racic spine manipulation for the management of musculoskeletal condi-tions: a systematic review and meta-analysis of randomized clinical trials. J Man Manip Ther. 2009;17:237-246. 6. Cleland J, Selleck B, Stowell T, Browne L, Alberini S, St. Cyears H, Caron T. Short-term effects of tho-racic manipulation on lower trapezius muscle strength. J Man Manip Ther. 2004;12:82-90. 7. Feuerherd R, Saliba S. Manual therapy for first-rib dysfunction. Athl Train Sports Health Care. 2013;5:5-6. 8. Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther. 2003;33:247-259. 9. Patla CE. E2: Extremity Integration. St Augustine, FL: Institute Press; 2002.

OPO130A NOVEL SOFT TISSUE MANIPULATION MOTION AND FORCE QUANTIFICATION SYSTEM FOR RESEARCH AND CLINICAL USETerry Loghmani, Bruce Neff, Sohel Anwar, Samantha Bane, Stanley Chien, Keith L. March, Allison Longgood, Colleen Quigley, Carolyn TobinPhysical Therapy, Indiana University, Indianapolis, Indiana; Mechanical Engineering, IUPUI-Purdue, Indianapolis, Indiana; Electrical Engineering, IUPUI-Purdue, Indianapolis, Indiana; Medicine, Indiana University, Indianapolis, IndianaPURPOSE: Soft tissue mobilization/manipulation (STM) is a type of manu-al therapy commonly used by therapists; the forces delivered during STM have not been adequately quantified in humans. This, however, echnolog-ical gap has markedly limited the ability to establish and compare realistic STM protocols and outcomes. Instrument-assisted soft tissue mobiliza-tion (IASTM), a type of massage that uses rigid devices, has demonstrat-ed therapeutic benefit. The purpose of this project was to fabricate and compare design concepts for an accurate and reliable mechano-therapeu-tic instrument that provides real-time quantification of motion and force delivered during IASTM for research and clinical use.DESCRIPTION: Two STM motion and force quantification (MFQ) system prototypes were designed, fabricated and compared. A system was se-lected for further development based on established criteria: precision, cost, maneuverability, and the ability to apply force to the soft tissue in a clinically replicable, user-friendly and feasible manner. The STM MFQ system consists of a 3-D compression load cell and a microcontroller. The 3-D compression load cell quantifies the force components in 3-D space, while the microcontroller measures the stroke angle and frequen-cy. Other parameters include total resultant force in 3-D, average peak force and treatment time. The accuracy of stroke angle measurements, frequency and maximal force measures during compression of the device at 90° and 45° angles were determined against external, calibrated scales. Preliminary intrarater and interrater reliability testing of force measure-ments between 2 trained, novice clinicians instructed to press the device at a 90° angle against an inanimate, flat surface for 15 trials at a perceived maximal clinical pressure was also performed.SUMMARY OF USE: The average ± SD force generated with the STM MFQ device held at a 90° angle device to the scale was 21.88 (4.9 lb) ± 4.18 N (0.94 lb), with a range of 15.38 (3.46 lb) to 30.11 N (6.77 lb). The accuracy of the device was excellent, within 1 N, for determining compressive force as compared to the external scale (n = 30 trials; at 90°, χ2 = 0.92; at 45°, χ2 = 0.97). Stroke angle and frequency were also accurate. Test-retest in-trarater reliability for examiner 1 was good (ICC = 0.619; 95% CI: –0.136, 0.872; P = .041). Interrater reliability between examiners 1 and 2 was also good (ICC = 0.653; 95% CI: 0.271, 0.835; P = .003).

test. Intrarater agreement was calculated using intraclass correlation co-efficients and Pearson correlation was used to assess interrater reliability.RESULTS: Intraclass correlation coefficients assessing the intrarater re-liability of the SDLLT in a population of young, healthy subjects sug-gests this is a highly reliable method to assess core activation and stabil-ity (0.885, P<.001). Interrater reliability using this methodology was also highly reliable (0.832, P<.001).CONCLUSIONS: These findings are consistent with the hypothesis that the SDLLT method described has high inter and intrarater reliability when assessing core stability and activation.CLINICAL RELEVANCE: It is necessary to utilize a reliable test to assess core stability and activation during physical therapy evaluation and treat-ment. Previously, researchers have described a subgroup of patients who would benefit from core stabilization in the treatment of low back pain and a clinical prediction rule has been developed for this subset of pa-tients [4,5,6]. Currently no gold standard for measuring this impairment has been described in the literature and there is inconsistency in how the SDLLT is performed [2,7]. This study demonstrates that the defined standardized method of measuring the SDLLT has good inter and intr-arater reliability and can be used to assess core stability. This study pre-pares the foundation for future planned studies to establish normative values for the SDLLT in the pediatric population.

OPO129TREATMENT OF THORACIC SPINE AND RIB IMPAIRMENTS IN A PATIENT COMPLAINING OF SHOULDER AND NECK PAIN: A CASE REPORTAlex Linko, Scott GetsoianUniversity of St Augustine for Health Sciences, St Augustine, FloridaBACKGROUND AND PURPOSE: To demonstrate the role of upper thoracic and rib joint hypomobility in shoulder pain and dysfunction. The upper ribs are commonly overlooked in the evaluation of shoulder and neck pain, but play an integral role concerning interregional interdependence.CASE DESCRIPTION: The patient was a 23-year-old female OT. She was hurt during a patient transfer. MRI was negative for a rotator cuff tear. Use of her right upper extremity increased pain. Isolated AROM of the shoulder and cervical spine were WNL. A limitation was noted with combined cer-vical right rotation and right shoulder external rotation. Joint mobility of the glenohumeral joint was WNL. P/A and rotational hypomobility was noted at C7/T1-T3/4 facet joints and costotransverse/vertebral joints [1-4]. During first rib assessment with the patient, I heard and felt a clunk with nearly all symptoms alleviated.OUTCOMES: After 9 treatment sessions, the patient was able to return to a full case load on an inpatient rehab unit. Joint and myofascial mobili-ty were WNL. The patient no longer had any pain complaints or difficul-ty transferring patients. Outcomes and function were assessed using the NDI and QuickDASH. Both were 0% at discharge.DISCUSSION: This case demonstrated the role of interregional dependence in a patient with shoulder pain. Initial thoracic spine and costotransverse/vertebral manipulation alleviated nearly all of the patient’s symptoms. Range of motion exercises and stretching were used as supportive treat-ments to manual therapy. Lower trapezius and middle trapezius were used to maintain improvements in joint and myofascial mobility. Combining upper thoracic and upper rib manipulation lead to a significant decrease in pain and increase in function. It is important to consider the thoracic spine and rib joints contribution to full shoulder and cervical range of mo-tion and function. Significant and rapid changes can be made in patient’s complaining of shoulder pain, when utilizing these techniques.REFERENCES: 1. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles Testing and Function With Pain and Posture. Baltimore, MD: Lippincott Williams and Wilkins; 2005. 2. MacDermid JC, Walton DM, Avery S, Blanchard AA, Etrum E, McAlpine C, Goldsmith CH. Measurement properties of the Neck Disability Index: a system-atic review. J Orthop Sports Phys Ther. 2009;39:400-417. 3. Mintken


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headache, migraine, and cervicogenic headache. J Orthop Sports Phys Ther. 2006;36:160-169. 2. Evers S. Comparison of cervicogenic headache with migraine. Cephalalgia. 2008;28:16-17. 3. Sjaatstad O. Cervicogenic Headache: comparison with migraine without aura: Vaga study. Cephalalgia. 2008;28:18-20. 4. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1:31-46. 5. Sahrmann S. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St Louis, MO: Elsevier Health Sciences; 2010. 6. McDonnell MK, Sahrmann SA, Van Dillen L. A specific exercise pro-gram and modification of postural alignment for treatment of cervico-genic headache: a case report. J Orthop Sports Phys Ther. 2005;35:3-15. 7. Porterfield JA, DeRosa C. Mechanical Neck Pain: Perspectives in Functional Anatomy. Philadelphia, PA: W.B. Saunders; 1995.

OPO132RELATIONSHIP BETWEEN THE FUNCTIONAL MOVEMENT SCREEN, HOP TEST, AND OTHER PERFORMANCE-RELATED PARAMETERS IN HIGH SCHOOL BASKETBALL PLAYERSPaul B. Lonnemann, Clinton W. Morris, Michael Fauser, Cody Mumaw, Gina L. PariserPhysical Therapy, Bellarmine University, Louisville, KentuckyPURPOSE/HYPOTHESIS: The Functional Movement Screen (FMS) has been shown to reliably assess an athlete’s risk of injury. Recent research has suggested that the Hop Test may also be able to assess asymmetry and risk of injury. However, there is little evidence correlating FMS scores to the Hop Test. Additionally, there is very little research relating scores from either assessment to athletic performance, specifically in basketball. This study aims to determine if there is a correlation between the FMS, Hop Test, and the NBA Draft Combine testing battery.NUMBER OF SUBJECTS: Twenty-five.MATERIALS/METHODS: Twenty-five participants selected from a high school basketball program were evaluated using the FMS, Hop Test, and select-ed tests adapted from the NBA Draft Combine. Data collected from these test batteries was then analyzed for significant correlations using either a Pearson or Spearman correlation statistic as appropriate.RESULTS: Pearson correlations for the data demonstrate statistically signif-icant relationships between the FMS and certain NBA Combine tests in-cluding the box drill and on the move shooting drill (r = –0.45 and 0.42, respectively). Right sided FMS scores were correlated with right sided single-leg timed hop and triple hops (r = –0.49 and 0.41, respectively). Left sided FMS scores were correlated with the single-leg timed hop, triple hop, and crossover hop (r = –0.63, 0.63, and 0.59, respectively). Individual components of the hop test were also correlated in some ex-tent to nearly all individual tests from the NBA Combine. Notable correla-tions were found between triple hop to standing vertical, max vertical, box drill, three-quarter-court sprint, and reactive shuttle drill (for right side: r = 0.60, 0.75, –0.74, –0.77, –0.62; for left side: r = 0.56, 0.70, –0.61, –0.78, –0.53, respectively) and between the single-leg timed hop and standing vertical, max vertical, box drill, three-quarter-court sprint, and reactive shuttle drill (for right side: r = –0.42, –0.63, 0.55, 0.66, 0.54; for left side: r = –0.45, –0.62, 0.58, 0.66, 0.48, respectively).CONCLUSIONS: These findings appear to support the hypothesis that com-ponents of the FMS, Hop Test, and NBA Combine Hop Test are correlat-ed with performance ability. Additionally, these correlations may indicate that the Hop Test is a tool that may potentially be utilized to determine an athlete’s risk of injury. More studies are needed to further examine the Hop Test as a reliable assessment of an athlete’s risk of injury and also to address the link between the FMS and Hop Test as predictors of athlet-ic performance.CLINICAL RELEVANCE: Correlating the FMS to athletic ability would allow clinicians in the field of sports performance to quickly and efficiently tar-get deficits to improve skill. The Hop Test may also be a reliable addition, or substitution, for the FMS in preseason physical screenings.

IMPORTANCE TO MEMBERS: A novel STM MFQ system was developed, dem-onstrating excellent accuracy and good reliability during preliminary test-ing. Future studies will further evaluate the system in animals and hu-mans. Ultimately, the ability to objectively characterize motion and force during manipulation of the soft tissue is important since it will permit protocols to be standardized and compared. Quantification of the forces delivered during soft tissue assessment and intervention is essential for this form of manual therapy to be validated and established as a viable mechanotherapy option for a variety of conditions.

OPO131TREATMENT OF CERVICOGENIC HEADACHE IN AN ADULT PATIENT USING THERAPEUTIC EXERCISES FOR CORRECTION OF MOVEMENT IMPAIRMENTS: A CASE REPORTMcKenzie D. LongPhysical Therapy, Orthosports Physical Therapy, Glendale, ArizonaBACKGROUND AND PURPOSE: Tension HA, cervicogenic HA, and migraine are the most prevalent types of HA among adults [1]. The prevalence of cervicogenic HA is estimated at 0.5% to 4% of the general population, but may be as high as 20% of points presenting with severe chronic HA [2,3,4]. A common postural impairment noted in this population is a for-ward head position with increased upper cervical extension [5]. This po-sition, when sustained or habitually repeated, produces increased stress on the cervical facet joints and is likely a contributing factor in cervico-genic HA or cervicalgia [5,6,7]. The purpose of this case report is to de-scribe evaluation and treatment of neck pain with tension HA and mi-graines. It will describe how education in proper postural alignment and therapeutic exercise can address impairments of the cervical and scapular regions to abolish cervicogenic HA symptoms.CASE DESCRIPTION: The patient was a 42-year-old woman with a medical diagnosis of “cervicalgia.” She worked from home 5 days a week and spent most of her time on a computer. She reported her migraines began at 14 years old. She also reported experiencing tension-HA, that would last for multiple days. She reported 4 d/mo symptom-free. At evaluation, she reported a tension-HA intensity of 3 to 4/10 that had been present for 48 hours. Location of pain was retro-orbital, suboccipital and radiated into her shoulders. Severity of tension-HA and migraine pain increased to 10/10, at worst. Her initial NDI score was 38, indicating complete dis-ability. Static alignment revealed extension of the upper cervical spine and decreased kyphosis in the thoracic spine, B scapular depression, ab-duction of the scapula, slight downward rotation of R scapula, and slight upward rotation of L scapula. She displayed cervical extension during B shoulder flexion, and cervical extension with vertebral rotation during unilateral shoulder flexion. Scapular elevation with capitol flexion cor-rected the movement faults. Strength deficits were identified in the low-er abdominals and deep neck flexors. These findings implicate poor mo-tor control and decreased strength as contributing factor to the cervical movement faults. Therapeutic exercises, postural education, and modali-ties were implemented. Exercises focused on correcting the alignment of the cervical and scapulothoracic regions by strengthening the deep cervi-cal neck flexors, middle and lower trapezius muscles, and lower abdomi-nals. She was seen over a period of 3.5 weeks for a total of 8 treatment ses-sions, each lasting approximately 60 minutes.OUTCOMES: The patient had decreased HA intensity to 0/10 by the sixth visit and neck pain to 0/10 by the seventh visit. Additionally, her postural control and awareness had improved at the conclusion of treatment and she reported decreased reliance on medication.DISCUSSION: The result of this case report suggest that therapeutic exercis-es focused on correcting posture and movement faults during ADLs can be helpful in reducing the symptoms associated with cervicogenic HA.REFERENCES: 1. Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC. Methodological quality of randomized con-trolled trials of spinal manipulation and mobilization in tension-type


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PURPOSE/HYPOTHESIS: The effectiveness of treatment for chronic, degener-ative conditions of the lumbar spine are largely influenced by patient per-ceptions in addition to the scientific rationale behind the intervention. Therefore, the primary purpose of this study was to understand the fac-tors that are important to individuals with lumbar spinal stenosis (LSS) regarding treatment for their condition. These factors were considered within the context of each treatment arm of the parent RCT.NUMBER OF SUBJECTS: Fifty individuals (28 female; average ± SD age, 73 ± 7.7 years) who had completed participation in a RCT for nonsurgical LSS treatment were invited to participate in focus groups to discuss per-ceptions about their study treatment, and their experiences with LSS in general. Treatment arms included usual medical care, community-based group exercise, and clinic-based manual therapy and individual-ized exercise.MATERIALS/METHODS: Six focus groups were conducted, 2 focus groups for each of the 3 treatment groups. Focus group topics included treatment ef-fectiveness, suggestions for treatment improvement, barriers and facilita-tors to treatment, and opinions of research outcome measures. A mixed approach was used to analyze focus group transcriptions; primary coding was focused on the research questions. Secondary coding sought to iden-tify themes concerning living with LSS and seeking treatment that were emergent from the focus groups.RESULTS: Five themes related to medical treatment and symptom man-agement arose from the focus group analyses: (1) a desire for individu-alized care based on self-management techniques; (2) a desire for edu-cation about LSS and motivation to pursue education from any available source; (3) positive and negative emotional responses to LSS symptoms and care; (4) the importance of social support in managing symptoms; and (5) seeking dietary changes and supplement use to improve symp-toms. These themes were consistent across all 3 treatment groups, with no substantial differences observed between the groups.CONCLUSIONS: Individuals with LSS are interested in reducing pain by any reasonable methods, which can lead to believing misinformation and con-sidering information from nonmedical sources, especially when medical providers do not take the time to explain the disease process and the the-ory behind treatment. Receiving individualized care focused on self-man-agement from an empathetic provider led to fewer negative emotions to-wards care and the disease process. Social support from family and others with LSS is also an important part of care.CLINICAL RELEVANCE: Clinicians should provide information about the dis-ease process and techniques for self-management in an empathetic man-ner. This will improve the likelihood that individuals with LSS have a pos-itive response to treatment. Individuals with LSS will seek empathetic care from nontraditional sources if they feel that traditional medical pro-viders are not providing appropriate or compassionate care.

OPO135TEST-RETEST RELIABILITY AND MINIMAL DETECTABLE CHANGE OF THE PATIENT-REPORTED OUTCOME MEASUREMENT INFORMATION SYSTEM PHYSICAL FUNCTION AND PAIN INTERFERENCE COMPUTER ADAPTIVE TESTS IN INDIVIDUALS WITH KNEE OAAndrew D. Lynch, Allyn M. Bove, Lan Yu, Paul A. Pilkonis, G. Kelley Fitzgerald, James J. IrrgangPhysical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania; School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaPURPOSE/HYPOTHESIS: To determine the test-retest reliability and estimate the minimal detectable change (MDC) score of the NIH’s PROMIS Pain Interference (PI) and Physical Function (PF) CATs in individuals with knee osteoarthritis (OA). We hypothesized that the CATs would demon-strate good test-retest reliability over clinically relevant time frames in in-dividuals who report no change in status.NUMBER OF SUBJECTS: Thirty-two individuals with knee OA (mean ± SD age, 62.0 ± 11 years old; 66% female) participated in up to 4 data collec-

OPO133BODY FUNCTIONS, ACTIVITY LIMITATIONS, AND PARTICIPATION RESTRICTIONS IN PATIENTS WITH CHRONIC LOW BACK PAIN WHO CHOOSE TO UNDERGO LUMBAR SPINE SURGERYAnat V. Lubetzky, Youssef Masharawi, Daphna Harel, Justin Burr, Thomas Errico, John Bendo, Marilyn MoffatPhysical Therapy, New York University, New York, New York; Physical Therapy, Tel Aviv University, Tel Aviv, Israel; Humanities and Social Sciences, New York University, New York, New York; Spine Surgery, New York University Langone Medical Center, New York, New YorkPURPOSE/HYPOTHESIS: Despite large variation in recommendations and quality of surgery-related clinical guidelines, approximately 3.2 million patients underwent low back surgery in the US in 2010 [1]. A shift to-ward a patient-centric “personalized’ approach to management encourag-es clinicians to account for individual characteristics of each patient [2]. No classification system currently directs the choice of surgical treatment [3,4]. Using the International Classification of Functioning, Disability and Health (ICF) Framework [5], the purpose of this study was to com-prehensively describe the body function, activities, and participation lev-els of patients who choose to go through lumbar decompression or fu-sion surgery.NUMBER OF SUBJECTS: Twenty-five adults (8 female, 17 male) with chron-ic low back pain who were recommended for lumbar spine surgery and chose to go through one, were tested prior to their surgery.MATERIALS/METHODS: Each patient went through a quick but compre-hensive battery of self-reported and functional tests. Questionnaires in-cluded the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMQ), Physical Activity Subscale of the Fear-Avoidance Beliefs Questionnaire (PA-FABQ), International Physical Activity Questionnaire (IPAQ), and numeric pain-rating scale (NPRS). Clinical measures included the 400-m walk test (400MWT), 8-ft timed up-and-go (TUG), Four Square Step Test (FSST), 30-second sit-to-stand test, Single-Leg Balance Test, Chair Sit and Reach Test, passive straight leg raise (PSLR), and single-leg heel rise (SLHR) test. Descriptive statistics for presurgical questionnaires and clinical measures were performed.RESULTS: Patients self-reported a minimum of 20 (minimal disability) to a maximum of 76 (crippling back pain) on the ODI; a minimum of 1 to a maximum of 21 on the RMQ; 0 to 10 for back or leg pain on the NPRS; and “not active” to “ highly active” on the IPAQ with 0 to 150 minutes of walking per week. The minimum to maximum on the PA-FABQ was 6 to 24. Eight patients completed the 400MWT in less than 5 minutes, 8 patients could not complete the test. The minimum to maximum on the TUG was 3.66 to 17.81 seconds and on the FSST was 4.56 to 23.2 seconds. The number of sit-to-stands performed in 30 seconds ranged between 2 to 29. Balance on a single leg was held between 0 to 30 seconds. Chair sit and reach ranged between –30 and +30 cm. PSLR ranged between 35° to 115° with 0 to 10 pain reported in either the back or the leg. The number of SLHR completed out of 20 ranged between 0 and 20.CONCLUSIONS: Results of body function, activity, and participation-level measures for these patients were from one end of the spectrum to the other. No single test demonstrated the ability to indicate the surgical need for all individuals tested. These patients will be followed up after surgery to see if any of the measures correlate with surgical outcomes.CLINICAL RELEVANCE: A comprehensive battery of measures at all ICF levels presurgery, may shed light on patients’ postsurgical outcomes.

OPO134INDIVIDUALS WITH LUMBAR SPINAL STENOSIS DESIRE EMPATHETIC CARE FOCUSED ON SELF-MANAGEMENT: RESULTS OF FOCUS GROUPS WITH RCT PARTICIPANTSAndrew D. Lynch, Allyn M. Bove, Michael J. SchneiderPhysical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania


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ed in supine and with the shoulder in the 90°/90° position for measuring ER and IR and supine with elbow extended for measuring shoulder FX and EX dynamic muscular strength.RESULTS: The mean dynamic strength ratios measured by 10 RM and Cybex did not approximate the values found in the literature. There is good to excellent internal consistency between 10 RM and Cybex for strength values. Cronbach’s alpha equal to .855 for ER, .898 for IR, .870 for FX, and .854 for EX. Strength ratios for ER:IR and FX:EX were not consistent between the 10 RM and Cybex, Cronbach’s alpha at .144 and .492 respectively. The 10 RM predicted Cybex dynamic strength measures for ER, IR, FX, and EX, but not for strength ratios. Comparison of instru-ments resulted in large effect sizes for independent strength values, but not for strength ratios.CONCLUSIONS: Finding a 10 RM on a weighted pulley system is a practical method that can be utilized in a clinical setting for finding shoulder mus-cle strength measurement that is comparable to Cybex testing. The ratio of ER/IR and FX/EX of the 10 RM weighted pulley system should not be compared to published results of ratio testing utilizing Cybex testing.CLINICAL RELEVANCE: Strength measurements of shoulder ER, IR, FX, and EX can be determined with the lower cost device of a pulley system that are comparable to a Cybex machine. The ratios of ER/IR and FX/EX strength found in the literature based on Cybex testing, however, do not equate with the ratios utilizing the pulley system.

OPO137EFFECTIVENESS OF A NOVEL KNEE UNLOADER BRACE FOR OSTEOARTHRITIS ON GAIT AND FUNCTIONAL PERFORMANCEKathleen C. Madara, Joseph Zeni, Federico PozziPhysical Therapy, University of Delaware, Newark, Delaware; Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CaliforniaPURPOSE/HYPOTHESIS: There are few noninvasive treatment options to stop the progression of osteoarthritis; however, unloader bracing reduc-es abnormal joint forces in the frontal plane and reduces pain. Recently, a novel knee unloader brace that reduces frontal plane forces and pro-motes more normal knee extension has become commercially available (Ongoing Care Solutions, Inc). The purpose of this study was to evaluate the effectiveness of a novel unloader brace with knee extension assist on functional measures and gait biomechanics after 6 weeks of use.NUMBER OF SUBJECTS: Thirty-two subjects completed this study; 18 (8 male, 10 female; age range, 50-78 years) in the control group and 16 in the brace group (8 male, 8 female; age range, 48-77 years).MATERIALS/METHODS: Patients were randomized into a Brace or No Brace group after baseline testing. Follow-up testing occurred 6 weeks after baseline assessment. Three dimensional gait data at a self-selected speed was captured using 8 infrared cameras (Vicon, Oxford, UK). Knee kinet-ics and kinematics were analyzed using Visual3D software. Functional tests (Timed Up and Go, Stair Climbing Test and Six Minute Walk) and isometric knee extension strength were assessed. Pain was assessed as worst pain, best pain, and average pain in the previous week on a scale of 0 to 10. Repeated measure ANOVAs were used to identify differenc-es in group and time. Both groups received a basic set of lower extremity stretches to be performed 3 times a week for 20 minutes. Subjects in the Brace group also were instructed to wear the brace for up to 8 hours a day. Subjects in the Brace group were seen after 3 weeks to ensure appropri-ate brace fitting and readjustments as needed. All testing was performed without the subject wearing the brace.RESULTS: There were no significant differences in gait biomechanics be-tween time or between groups. There was a significant interaction effect for “worst pain” (P = .003) and post hoc testing revealed the brace im-proved from a 7/10 at baseline to 4/10 at follow-up (P = .006). There was no change for the control group (6/10 at baseline and follow-up, P = .849). There was an effect of time for the stair climb test (P = .02) and best reported affected knee pain (P = .050).

tion sessions.MATERIALS/METHODS: Participants were asked to complete the PROMIS PF and PI CATs at a baseline session, and at follow-ups of 1, 3, and 6 months. Participants answered a 15 point global rating of change (GRC) question at each follow-up. We operationally defined a participant to be stable if they responded they were “hardly any worse at all” (–1), “about the same” (0), or “hardly any better at all” (1) on the GRC. Scores outside of this range were categorized as not stable. We compared the follow-up CAT scores to the baseline CAT scores for each cohort of stable partici-pants and summarized change scores. Test-retest reliability was assessed with a 2-way Random Effects Intraclass Correlation Coefficient for abso-lute agreement of single measures (ICC model 2,1). We operationally de-fined an ICC2,1 of 0.75 to indicate good test-retest reliability. Based on the ICC2,1, an MDC was calculated.RESULTS: Follow-up was obtained from 27 participants at 1 m (84%), 30 participants at 3 m (94%) and 28 participants at 6 m (88%). On average, participants completed the PF CATs in 4.1 items (range, 4-6 items) and PI CATs in 5.5 items (range, 4-13 items). For the PROMIS PF CAT, aver-age change scores were all less than 1.5 points and all ICC2,1 values were greater than 0.8, but tended to decrease over time. MDC values were 8 points at 1 m, 7.4 points at 3 m, and 5.7 points at 6 m, with upper limits of the 95% of confidence intervals less than 12.3 points. PROMIS PI CAT scores were not reliable over time (ICCs ranged from 0.56 to 0.69), and point estimates of the ICC were not precise as indicated by the wide con-fidence intervals (eg, 1 m; ICC2,1 95% CI: 0.04, 0.84 points). Poor reliabil-ity led to large MDC values (13.8-17.9 points).CONCLUSIONS: The PROMIS PF CAT is a reliable and efficient measure in individuals with knee OA over periods of 1, 3, and 6 months. Depending on the time frame, changes less than 8 points may be attributed to mea-surement error, and changes greater than 12 points would be considered a true change in physical function. The PROMIS PI CAT is not a reliable measure in individuals with knee OA, potentially due to the variable na-ture of pain with OA.CLINICAL RELEVANCE: The PROMIS PF CAT can be used with individuals with knee OA over time, with changes greater than 8 points likely indicat-ing a change beyond measurement error. Future work to establish PF CAT responsiveness and minimal clinically important differences is needed.

OPO136THE RATIO OF MUSCLE STRENGTH BETWEEN EXTERNAL/INTERNAL ROTATION AND FLEXION/EXTENSION OF THE SHOULDER MEASURED WITH A CYBEX ISOKINETIC UNIT COMPARED TO A 10-REPETITION MAXIMUM USING A PULLEY SYSTEMAngela MacCabe, Richard A. Ekstrom, Steven Bloom, Kelsey R. Tobin, Kory ZimneyPhysical Therapy, University of South Dakota, Vermillion, South DakotaPURPOSE/HYPOTHESIS: The objectives of our study were (1) to deter-mine shoulder external rotation (ER):internal rotation (IR) and flexion (FX):extension (EX) muscle strength ratios for the shoulder using both a Cybex isokinetic unit and a 10 repetition max (RM) on a weighted pulley system and (2) to determine if ER/IR and FX/EX strength ratios mea-sured by 10 RM predict strength ratios measured by a Cybex isokinet-ic unit.NUMBER OF SUBJECTS: Twenty subjects without shoulder dysfunction were recruited to participate in the research protocol.MATERIALS/METHODS: Prospective, single-group, repeated measures de-sign. Shoulder muscle strength ratios were measured utilizing a Cybex isokinetic machine set at 90°/s and by finding a 10 RM on a weighted pul-ley system. On the first day of testing, subjects were tested on the isokinet-ic machine and also found an approximate 10 RM on the weighted pulley machine. Two days following, the subjects found their true 10 RM on the weighted pulley machine. A metronome was used in calculating the 10 RM to mimic the speed of the isokinetic machine. All subjects were test-


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CLINICAL RELEVANCE: This novel therapy protocol may be more appropriate and provide better clinical outcomes than traditional rehabilitation given the changing patient demographics.

OPO139TREATMENT OF UNILATERAL SCAPULAR DYSKINESIS AND PAIN IN A HEALTHY, ACTIVE ADULT: A CASE STUDYEvan J. MadsenCPRS Physical Therapy, Mifflintown, PennsylvaniaBACKGROUND AND PURPOSE: The purpose of this study was to discuss treat-ment of a healthy, high functioning adult with scapular pain. It was hy-pothesized that in the absence of strength, muscular endurance, ROM, and glenohumeral joint mobility deficits, improving scapular control through neuromuscular re-education alone would effectively restore scap-ular positioning and normal scapular rhythm, thereby reducing pain and functional limitations.CASE DESCRIPTION: The subject was evaluated with complaints of fluctuat-ing scapular pain that hindered his ability to sleep, exercise, and perform his usual work duties. Upon examination, he was found to have no muscle endurance, ROM, or glenohumeral joint mobility deficits, and minimal strength deficits. Upon visual inspection of his scapulae, the patient was found to have an obvious scapular dyskinesis of his involved scapula when weight bearing through the upper extremities. An attempt was made to objectify this asymmetry using the lateral scapular slide test (LSST). This scapular dyskinesis was used as the basis for treatment, which included verbal and tactile cuing for scapular movement quality as well as neuro-muscular re-education for scapular stability and control.OUTCOMES: The patient was seen in the clinic for a total of 14 visits. The QuickDash and NDI outcome measures improved from 13.6% and 12%, respectively, to 0% at discharge. Objective measures were taken once weekly, except for the LSST, which was performed pretreatment and post-treatment at each therapy visit; however, there are visits where the LSST was not performed due to clinical constraints. The patient’s initial pain of 1 to 4/10 at initial visit was resolved by discharge. At the initial visit, man-ual muscle testing of the middle scapula, lower scapula, and shoulder ex-ternal rotation revealed minimal strength deficits, which improved slight-ly by discharge. The differences in the right and left scapular positions varied by as much as 2.5 cm with the LSST, but trended toward improve-ment and were symmetrical at discharge. The patient reported full return to his prior level of function without restriction at discharge.DISCUSSION: The results of the LSST showed a consistent trend toward im-provement in scapular symmetry, both within therapy sessions and be-tween therapy sessions. However, the LSST has poor reliability, specific-ity, and sensitivity, and obvious scapular dyskinesis in weight bearing was visualized throughout treatment to discharge. This not only reinforces the need for further research into development of a valid and reliable objec-tive measure for scapular dyskinesia, but also raises the question of how one can improve pain and function without changing the position of the scapula in functional positions. In this case scenario, it is hypothesized that the patient’s resolution of pain and full return to prior level of func-tion was due to neuromuscular re-education of the scapulothoracic mus-culature resulting in improved control throughout the movement pattern rather than improved positioning of the scapula.REFERENCES: Kibler BW, McMullen J, Uhl T. Shoulder rehabilitation strat-egies, guidelines, and practice. Oper Tech Sports Med. 2012;20:103-112. Kibler BW, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “scapular summit’. Br J Sports Med. 2013:1-12. McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. A clini-cal method for identifying scapular dyskinesis, part 1: reliability. J Athl Train. 2009;44:160-164. Shadmehr A, Bagheri H, Ansari NN, Sarafraz H. The reliability measures of lateral scapular slide test at 3 different de-grees of shoulder joint abduction. Br J Sports Med. 2010;44:289-293. Uhl TL, Kibler BW, Gecewich B, Tripp BL. Evaluation of clinical assessment

CONCLUSIONS: There were no biomechanical benefits of wearing the brace for 6 weeks, but individuals in the Brace group did demonstrate a signif-icant and important reduction in the worst pain outcome. This may in-dicate that wearing the brace was able to reduce painful flares in the ex-perimental group. Both groups improved over time for the stair climbing test and the “best knee pain.” These improvements may be attributed to the stretching protocol that was identical in each group. The duration of wear was only 6 weeks and most previous research has evaluated biome-chanical and functional outcomes over a longer period of wear time. The shorter time between testing sessions may contribute to the lack of differ-ence between groups.CLINICAL RELEVANCE: This unloader brace is a promising noninvasive treat-ment option for patients with osteoarthritis who experience high levels of knee pain.

OPO138NOVEL REHABILITATION PROTOCOL TO RETURN PATIENTS TO HIGH-LEVEL ACTIVITIES, SPORTS, AND OCCUPATIONS AFTER TOTAL HIP ARTHROPLASTYKathleen C. Madara, Joseph Zeni, Leo W. RaisisPhysical Therapy, University of Delaware, Newark, Delaware; First State Orthopaedics, Newark, DelawarePURPOSE/HYPOTHESIS: Individuals undergoing total hip arthroplasties (THA) are getting progressively younger. Although the surgical tech-niques and biomaterials have improved, rehabilitation has not kept pace with the goals and expectations of this younger patient demographic. The purpose of this study was to evaluate the feasibility and effectiveness of a treatment intervention protocol that included progressive strengthening and high-level activity retraining.NUMBER OF SUBJECTS: Seven subjects completed this ongoing clinical study; 3 subjects in the control group (age range, 58-70 years; 2 female, 1 male) and 4 in the experimental group (age range, 53-70 years; 1 female, 3 male).MATERIALS/METHODS: The experimental intervention was novel with re-spect to timing and content. The experimental group received 16 ses-sions over 16 weeks. Subjects were seen once every 2 weeks for the first 12 weeks, followed by 3 times a week for 4 weeks. Training was tailored to individual patient goals, but included a comprehensive and progres-sive home exercise program, biofeedback to promote movement sym-metry, progressive strengthening and high level activities in the later stage. The control group received usual care and the timing and content of rehabilitation was not constrained. Testing included 3-D gait analy-sis (Vicon Motion Systems Ltd, Oxford, UK) and functional and clini-cal measures (Timed Up and Go, Stair Climbing Test, and 10-point pain scores). Change scores for each group were calculated and compared us-ing independent t tests. Biomechanical variables included peak vertical ground reaction force (vGRF), peak hip adduction angle, and external peak hip adduction moment.RESULTS: The experimental group had a 9.35% increase in peak vGRF compared to a 0.37% increase in the control group (P = .04). Hip ad-duction increased 4.58° in the control group, whereas the experimen-tal group increased 1.99° (P = .122). There was a 10.26% increase in the hip adduction moment in the experimental group, while the control in-creased 2.26% (P = .720). Hip pain decreased 3.5 points in the experi-mental group, but there was no reduction in pain in the control group (P = .009). Both groups improved in the Timed Up and Go. The experimen-tal group had substantial improvement in stair climbing time (8.4 sec-onds) compared to the control group (1.15 seconds) (P = .472). Similarly, the experimental group increased Six-Minute Walk Distance by 147.1 m, while the control increased 39.6 m (P = .138).CONCLUSIONS: This novel treatment protocol is feasible in a clinical setting and had a positive impact on function and hip biomechanics. The exper-imental group had improved joint kinetics and dramatic improvements in performance by 16 weeks. Differences between groups were fairly large and the lack of significance is likely attributed to the low sample size of this preliminary analysis.


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creased energy expenditure (EE), and risk for falling. The timed up and Go (TUG) and 6 minute walk test (6MWT) are frequently used to deter-mine fall risk by means of a single score. Additionally, sharp turns, as in-volved in TUG and 6MWT, suggest quality of turns, and not only distance walked, can increase EE. This report compared temporospatial compo-nents of gait and EE in an individual using assistive devices over 3 differ-ent time points during the TUG and 6MWT.CASE DESCRIPTION: The subject was a 44-year-old woman who developed a dropped foot following a fall shortly after a L4-S1 fusion. Prior to sur-gery she was an active individual and a former gymnast. She presented with diminished patellar and Achilles reflexes of 1/4 and 2/4 respectively, and diminished sensation of the left lower extremity (LE). MMT for her LLE was: hip flexion 4/5; knee extension 4/5; tibialis anterior 1/5; exten-sor hallucis longus 1/5 and heel raises 3/5. She ambulated with a straight cane and a customized ankle-foot orthosis (AFO). Data were collected at 3 time points separated by at least 1 week. However, on return for the sec-ond session she related that she had a fall at home several days previously.OUTCOMES: The subject used her AFO for session 1, while she used her cane and AFO for sessions 2 to 3. A Kinesis QTUG wireless system was used to acquire temporospatial parameters. Energy expenditure (EE) was assessed using the energy expenditure index (EEI) and the Borg scale of perceived exertion. Times to complete the TUG were 7.7, 9.1, and 7.3 sec-onds and velocity was 0.78, 0.66 and 0.82 m/sec for sessions 1 to 3, re-spectively. Velocity decreased approximately 18% while cadence (24%) and stance time (20%) decreased from session 1 to session 2. 6MWT EEI for sessions 1 to 3 was 0.64, 0.28 and 0.34 beats/min, while velocity was 1.78, 1.4 and 1.75 m/secs and distance (6MWD) covered was 653, 520 and 632 m, respectively. 6MWT velocity was approximately 50% faster than the TUG, while cadence for the 6MWT versus TUG differed (mean, 127 versus 115.9 steps/min) across all sessions with average stride length re-maining consistent. Surprisingly, turning efficiency was not affected by the fall. EEI correlated with 6MWD (r = 0.72), Borg score (r = 1), and gait velocity (r = 0.54). By session 3 most parameters had returned to at least prefall levels.DISCUSSION: The availability of portable wireless technology provides a plethora of real-time data that is not readily apparent from the TUG and 6MWT. This case report showed the impact of a fall was apparent from TUG and 6MWT scores. However, the value in being able to quantify key biomechanical inefficiencies contributing to such scores using the QTUG could lead to targeted interventions to specific components which are readily identifiable. Moreover, such a device can provide objective infor-mation on patient response to treatment and could result in considerable time cost savings with regard to productivity and outcomes assessment..REFERENCES: Smith E, Walsh L, Doyle J, Greene B, Blake C. The reliability of the quantitative timed up and go test (QTUG) measured over 5 consec-utive days under single and dual-task conditions in community dwelling older adults. Gait Posture. 2016;43:239-244. Horak F, King L, Mancini M. Role of body-worn movement monitor technology for balance and gait rehabilitation. Phys Ther. 2015 ;95:461-470. Justine M, Manaf H, Sulaiman A, Razi S, Alias HA. Sharp turning and corner turning: com-parison of energy expenditure, gait parameters, and level of fatigue among community-dwelling elderly. Biomed Res Int. 2014:1-6. Schrack JA, Simonsick EM, Chaves PHM, Ferrucci L. The role of energetic cost in the age-related slowing of gait speed. J Am Geriatr Soc. 2012; 60:1811-1816. Bregman DJJ, Harlaar J, Meskers CGM, de Groot V. Spring-like an-kle foot orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture. 2012; 35:148-153.

OPO142EFFECTIVE ELECTRONIC BEHAVIOR MODIFICATION TOOL FOR SEATED POSTUREAdam J. Malek, Julie B. Barnett, Zachary R. Johnson, Jennifer Croft, Margaret W. NortonPhysical Therapy, University of Texas Health Science Center San

methods for scapular dyskinesis. Arthroscopy. 25:1240-1248.

OPO140IN VIVO ULTRASOUND OF RADIAL-HEAD MOTION AND EFFECT OF MOBILIZATION DIRECTION ON FOREARM RANGE OF MOTIONRuth M. Maher, Megan R. Bureau, Melissa A. Conway, Paul Ellington, Amber Harrison, Chelsey ThornsberryThornsberry, Physical Therapy, Shenandoah University, Leesburg, Virginia; Physical Therapy, UAMS-Northwest, Fayetteville, ArkansasPURPOSE/HYPOTHESIS: Describe the motion of the radial head during fore-arm pronation and supination using real-time ultrasound (US) imaging and determine the immediate effects of joint mobilization.NUMBER OF SUBJECTS: Forty-three subjects (32 female, 11 male; mean age, 29 years) with normal upper extremity (UE) range of motion.MATERIALS/METHODS: The experimental UE was randomly selected and as-sessed in full elbow extension and 90° of elbow flexion. An adjustable height table was used to standardize positioning while the glenohumer-al joint was stabilized. Subjects performed pronation and supination from neutral synchronized to a metronome at 60 bpm. Ultrasound (US) cineloops were recorded using a linear transducer oriented in the trans-verse plane over the radial head. Subjects were then randomized to re-ceive an anterior or posterior radial head mobilization the rate of which was standardized at 2 Hz (120 bpm) with a metronome. Range of motion (ROM) measurements were taken premobilization and postmobilization.RESULTS: US showed the radial head rolled in an anteromedial direc-tion during pronation and a posterolateral direction during supina-tion. No translation was evident on US imaging in the transverse plane. Multivariate analysis revealed significant interaction effects (P = .02; power, 0.66) between direction of mobilization and ROM and elbow po-sition and ROM (P = .03; power, 0.60). Post hoc ROM analysis revealed anterior mobilization significantly increased passive pronation (P = .040) while significantly decreasing active supination (P = .045) when assessed in full extension but significantly increased active supination (P = .037) when assessed in 90° of flexion. Posterior mobilization significantly in-creased ROM for active supination (P = .028) while significantly decreas-ing passive pronation (P = .044) in 90° of flexion.CONCLUSIONS: Studies have reported translatory motion of the radius that contrasts with that opined by the convex-concave rule which therapists frequently use to determine the direction of joint mobilization. Our find-ings appear to support previous findings which question the application of the convex-concave rule, albeit we did not note any translation which may be a consequence of imaging in 1 plane and the magnitude of trans-lation. Neumann has postulated that the rule is not flawed but misinter-preted as it was not intended for use to enhance joint motion but merely to describe physiological joint motion. The motion in pathological joints by definition may be different. Should we now reconsider application of the convex-concave rule as a means of improving joint motion or just mo-bilize based on where the restrictions are?CLINICAL RELEVANCE: Elbow trauma often leads to deficits in PRUJ motion which can be difficult to treat given the complexity of the joints involved. This study is in agreement with others which have reported inconsisten-cies which are paradoxical to the convex-concave rule. Further study is required to determine if current mobilizations are efficacious and if the technique should be changed given recent findings.

OPO141DETERMINING CONTRIBUTING FACTORS TO OUTCOME MEASURE SCORES USING TRIAXIAL WEARABLE SENSOR TECHNOLOGY IN AN INDIVIDUAL USING A STRAIGHT CANE AND ANKLE-FOOT ORTHOSISRuth M. Maher, Devon G. Cota, Sonal ShethPhysical Therapy, Shenandoah University, Leesburg, Virginia; Physical Therapy, UAMS-Northwest, Fayetteville, ArkansasBACKGROUND AND PURPOSE: There is a strong association between gait, in-


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MATERIALS/METHODS: A retrospective chart review was performed to de-termine the relationship between the FMS total score and musculoskele-tal injury, and single-leg hop tests and musculoskeletal injury. All recruits were scored on the FMS at the beginning of a fire academy. All recruits completed 4 single-leg hop tests at the beginning of the fire academy: single-leg hop test, triple hop test, crossover hop test, and 6-m hop test. The criterion used to define musculoskeletal injury was that the recruit was referred to occupational health during the fire academy. Descriptive statistics were calculated for the sample and for the FMS and single-leg hop tests data. To determine if there was a significant difference between the FMS total score of injured recruits and uninjured recruits a Mann-Whitney U test was performed. A crosstabulation table was used to cal-culate the relative risk of injury with a FMS total score of 14 or less. The Mann-Whitney U test was used to identify significant differences between injured and uninjured recruit single-leg hop test scores.RESULTS: Fifteen percent of the recruits (n = 60) had a musculoskeletal in-jury during the fire academy. There was not a significant difference be-tween injured recruit and uninjured recruits for the FMS total score or the single-leg hop tests. The incidence of injury among recruits with a FMS total score of 14 or less. The incidence of injury among recruits with a FMS total score greater than 14 was 15%. The relative risk for muscu-loskeletal injury with an FMS score of 14 or less was 0.81. The P value (.83) associated with the relative risk indicates that the 2 groups were not different.CONCLUSIONS: There was not a significant difference between the FMS to-tal scores of injured and uninjured recruits. The mean FMS total score for all recruits indicates that most recruits were able to complete the FMS with minimal or no compensations. There was not a significant differ-ence between the single-leg hop test scores of injured and uninjured re-cruits. The crossover hop for distance test displayed the largest difference in scores between the injured and uninjured results.CLINICAL RELEVANCE: The FMS total score and single-leg hop tests were not associated with musculoskeletal injury during a fire academy.

OPO144RELATION BETWEEN RANGE OF MOTION AND PHYSICAL ACTIVITY WHILE RECOVERING AFTER TOTAL KNEE REPLACEMENTHiral Master, Louise M. Thoma, Oliver Yost, Meredith B. Christiansen, Ryan Green, Laura A. A. Schmitt, Daniel WhitePhysical Therapy and BIOMS, University of Delaware, Newark, DelawarePURPOSE/HYPOTHESIS: Standard postoperative physical therapy (PT) for total knee replacement (TKR) aims to increase knee range of motion (ROM), which is important for walking and adopting an active lifestyle, eg, taking more steps/day, after TKR [1-3]. However, it is unclear to what extent limited ROM may be a barrier to physical activity after TKR. This is important to study since ROM is a modifiable impairment that can be prioritized in PT after TKR. The purpose of this study was to evaluate the association of ROM with physical activity over the first 6 weeks of PT af-ter TKR.NUMBER OF SUBJECTS: We recruited 26 patients with a first time unilateral TKR from a local PT clinic. We excluded people with comorbidity that af-fected physical function other than arthritis.MATERIALS/METHODS: We quantified physical activity as steps/day using an accelerometer enabled monitor (Actigraph GT3X) worn for at least 3 days during waking hours. Knee ROM was measured by a physical ther-apist using a standardized approach. We classified lacking greater than 5° of full knee extension as limited extension and knee flexion less than 95° as limited flexion [4]. We examined the difference in steps/day be-tween those with and without limited knee ROM with physical activity each week of PT (weeks 1 to 6) using difference tests and 95% confidence intervals (CIs).RESULTS: We included 26 people after TKR (mean ± SD age, 64.9 ± 9.1

Antonio, San Antonio, TexasPURPOSE/HYPOTHESIS: Prior studies have shown new digital technologies are effective in significantly measuring and improving spinal posture when individuals have worn accelerometer/gyroscope sensors with real-time biofeedback that measure changes in lumbopelvic angle [1-3]. The purpose of this study was to determine if a lumbar sensor-based accel-erometer and gyroscope technology (LUMOback), when combined with posture education could effectively modify seated lumbar postural behav-ior during prolonged sitting.NUMBER OF SUBJECTS: Seventeen health science students were randomly as-signed into 4 test groups.MATERIALS/METHODS: Test groups consisted of: (1) Control Group (2) LUMOback Visual Feedback Group with posture education (3) LUMOback Vibration Biofeedback Group with posture education (4) LUMOback Visual and Vibration Biofeedback Group with posture edu-cation. All subjects attended a pre and post photographic postural evalua-tion, answered a postural/device questionnaire, and wore the LUMOback sensor in a seated posture for 8 (±18 minutes) hours a week for 4 weeks. Postural score (PS) data representing the percent of time maintained in neutral lumbopelvic was collected. Data analysis: nonparametric tests were utilized to determine if there were differences between mean PSs and if experimental groups demonstrated better mean PSs than the con-trol group.RESULTS: All 3 experimental groups had different average daily PSs when compared to controls. The Visual/Vibration group demonstrated the highest postural scores on a daily basis when compared to the Control, Visual, and Vibration groups. Intragroup comparisons of PSs from the first and last day of testing for all 4 groups showed a significant improve-ment in mean PSs. On the first and last day of testing, all 3 test groups had significantly higher mean posture scores than controls. The Visual/Vibration had the highest final mean PSs (99.2). Additionally, Visual/Vibration PSs were found to be significantly greater than the PSs of both Visual and Vibration groups, while Vibration PSs were also significantly higher than Visual group PSs.CONCLUSIONS: The results of the study indicate the LUMOback sensor was an effective electronic behavior modification tool for changing seated posture in health science students while they were donning the device. The posture survey indicated that all experimental and control subjects perceived the quality of their posture had improved over the course of the study.CLINICAL RELEVANCE: An accelerometer/gyroscope with real-time biofeed-back and postural education could be utilized by individuals who are re-quired to maintain a seated posture for prolonged periods of time to im-prove seated posture. Theoretically, this can improve recall and learning [4]. This type of technology could also assist clinicians to maintain an op-timal seated posture while performing clinical duties, thereby improving patient perceptions [5]. Finally, the LUMOback could be an effective tool used to monitor patient performance of therapeutic activities and exercis-es in a neutral lumbopelvic posture.

OPO143THE ASSOCIATION OF THE FUNCTIONAL MOVEMENT SCREEN AND SINGLE-LEG HOP TESTS WITH MUSCULOSKELETAL INJURY IN FIREFIGHTER RECRUITSCory Manton, Benjamin Erbe, Jennifer S. Iyo, Katherine Randau, Levi StreetPhysical Therapy, A.T. Still University, Scottsdale, ArizonaPURPOSE/HYPOTHESIS: The purpose of this study was to determine if the Functional Movement Screen (FMS) total score of 14 or less and/or sin-gle-leg hop tests were associated with musculoskeletal injury in firefight-er recruits. It was hypothesized that both an FMS total score of 14 or less and lower single-leg hop test scores would be associated with musculo-skeletal injury in firefighter recruits.NUMBER OF SUBJECTS: Data from 60 firefighter recruits (59 male) were an-alyzed for this study.


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ADAM Center, New York, New York; Callan-Harris Physical Therapy, PC, Rochester, New York; Exchange Place Physical Therapy Group, Jersey City, New JerseyPURPOSE/HYPOTHESIS: In-house physical therapy management of work-re-lated musculoskeletal injuries (WMSI) in a professional dance organiza-tion demonstrated decreased new time-loss injuries (TLinj) in dancers over a 6-year period. The objectives of this study were to identify injury patterns and determine changes in injury rates over 15 years.NUMBER OF SUBJECTS: Forty-two professional modern dancers: 30 senior (Sr) and 12 junior (Jr) company dancers (male-female ratio = 1:1; mean ± SD age, 26 ± 5 years).MATERIALS/METHODS: Due to annual turnover in both companies, 158 danc-ers participated in this study. Prospective cohort data were obtained over a 15-year time period, tracking new WMSI, TLinj, diagnoses, and ex-posure hours. Injury data were excluded from analysis if sustained out-side of working hours, or defined as re-injury if occurring within 8 weeks of original diagnosis. The 15 years were divided into 5 3-year blocks for comparison. Injuries occurring during each Block were converted to injuries/1000-h dance exposure to allow comparisons. Quasi-Poisson analysis was used to correct for over-dispersion of the data, P<.05. Exposure hours were converted to the natural log and used as the offset variable. Block (B), company (Sr versus Jr), sex, and years of professional dance experience were categorical predictors for the dependent variables: WMSI, TLinj, traumatic and overuse injury.RESULTS: One hundred eight of 158 dancers (68%) reported WMSI. Of these, 74 (47%) sustained at least 1 TLinj. Average annual dance expo-sure was greater in Sr dancers (157 performances and 40 weeks/years) compared to the Jr company (76 performances and 33 wk/y; P<.01). Sr dancers were 1.5 times more likely to sustain TLinj (Incident rate ra-tio [IRR] = 1.548, P = .030); and twice as likely to sustain overuse inju-ries (IRR = 2.154, P = .001) compared to Jr dancers. TLinj averaged 0.16 injuries/1000-h exposure over the 15 years. The overall ratio of trauma to overuse injuries was 64:36 for TLinj. Blocks B2, B3 and B5 demonstrat-ed decreased TLinj/1000-h compared to B1 when the program was initi-ated, P≤.008. There were no differences due to sex or experience. Lower extremity injuries occurred most frequently (greater than 62% of total).CONCLUSIONS: Injury rates in Sr dancers exceeded those of Jr dancers, re-flecting differences in hours of exposure between companies. Block 4, de-spite an increase in TLinj (0.23/1000-h), remained lower than those re-ported in ballet companies with in-house management programs. Lower extremity injury patterns were consistent with prior reports. Reports of professional dance injuries/1000-h exposure are lower than those report-ed for sports such as gymnastics, soccer, and running. This is the lon-gest study to date supporting the effectiveness of in-house comprehen-sive management.CLINICAL RELEVANCE: Periodic re-examination of an in-house physical ther-apy program is important to determine whether it continues to be effec-tive in preventing and minimizing injury.

OPO147UTILIZATION OF A PAIN MECHANISM CLASSIFICATION TOOL IN CLINICAL PRACTICEJanna M. McGaugh, Memrie D. FergusonDepartment of Physical Therapy, University of Texas Medical Branch, Galveston, TexasPURPOSE/HYPOTHESIS: The success of a classification system is based on its ability to guide assessment and facilitate the selection of appropriate treatment interventions. The accurate classification of pain type should enable the clinician to select interventions hypothesized to target the spe-cific mechanisms involved in pain signal generation and maintenance. Current evidence suggests there are 3 clinically meaningful categories for musculoskeletal pain: nociceptive pain (NP), peripheral neuropathic pain (PNP), and central sensitization (CS). The purpose of this pilot study was to investigate the utilization of a Pain Classification Tool (PCT) in deter-

years; BMI, 34.5 ± 7.5 kg/m2; 56% female) at baseline. Participants walked 1889 ± 1467 steps/d at week 1, and 3474 ± 2277 step/d at week 6. In general, there was little difference in steps/day between those with and without limited ROM. For instance, there was a nonstatistically signifi-cant difference in steps per day between those with limited extension (n = 20) compared with those without (n = 6) (776 steps/d; 95% CI: –2185, 633.26). In a similar fashion, there was little difference among those with limited flexion (n = 7) compared with those without (538 steps/d; 95% CI: –818, 1894). A small difference was observed at week 6 for extension. No participants had limited flexion after week 3.CONCLUSIONS: Our preliminary findings show little difference in physical activity among people with and without ROM limitations after TKR.CLINICAL RELEVANCE: Clinically significant limited ROM may not be a ma-jor barrier to physical activity after TKR. Directing PT interventions to areas other than ROM are important to consider after TKR to increase physical activity.

OPO145PHYSICAL THERAPY UTILIZATION FOLLOWING AN EMERGENCY DEPARTMENT CONSULTATION FOR LOW BACK PAINLloyd Mayer, Dave Larson, Tasha Olsen, Andrew Bernstetter, Lee Skinner, John S. MagelUniversity Orthopaedic Hospital, Department of Physical Therapy, University of Utah, Salt Lake City, UtahPURPOSE/HYPOTHESIS: The health care pathways through which patients with LBP access and receive care are variable [1,2]. The timing of physical therapy (PT) after accessing health care may influence health care utili-zation and costs [3,4]. The emergency department is a health care access point for many patients with LBP [5]. Little is known, however, regard-ing subsequent health care utilization. The purpose of this study was to evaluate the utilization and timing PT services following a new consulta-tion to the ED for LBP and to describe the efforts to improve PT access.NUMBER OF SUBJECTS: One thousand four hundred fifty-three.MATERIALS/METHODS: This was a retrospective cohort study of patients who accessed the University of Utah Emergency Department for LBP between January 1, 2013 through December 31, 2014. Subjects were included if they had a new consultation to the ED with an associated LBP-related ICD-9 code and had no claims with a LBP-related ICD-9 and ICD-10 code for any service or provider in the preceding 90 days. We defined the date of the ED visit as the index visit. Participants were excluded if they had any red flag (fracture, cauda equine syndrome, infection, etc), neu-rologic condition (stroke, Parkinson’s disease) or spinal cord injury at the time of the index visit. Health care utilization was recorded during the 1-to-14- and 15-to-90-day period following the index visit.RESULTS: The average ± SD age of our cohort was 59.4 ± 18.3 years) and was 50.3% female. Two hundred thirty-eight patients had LBP-related health care services in the 1-to-14-day period following the index visit and 0 (0%) accessed PT. Seven hundred fifty-one patients (51.6%) had a LBP-related consultation to a provider for the first time in the 15-to-90-day pe-riod following the index visit, 11 (0.01%) of which were for PT. An effort to improve PT access has been initiated. ED and PT providers have teamed to implement a physical therapy pathway. Technicians have modified the electronic medical record to assist ED providers in initiating an imme-diate referral to PT. Physical therapy access is currently being tracked.CONCLUSIONS: Physical therapy services following a new consultation to the ED for LBP are underutilized. Quality improvement efforts may to improve future physical therapy access to these patients.CLINICAL RELEVANCE: Delaying physical therapy services to patients follow-ing a consultation to the ED for LBP may be suboptimal care.

OPO146MUSCULOSKELETAL INJURIES IN PROFESSIONAL MODERN DANCERS: A 15-YEAR PROSPECTIVE COHORT STUDYCaroline D. McBride, Shaw Bronner, Allison Gill


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stretch position, F15,166 = 14.67, P<.0005, Wilk’s λ = 0.097, partial η2 = 0.540. The greatest length change for the SP (30.7 ± 10.2 mm) and IP (23.7 ± 7.8 mm) as well as the SG (20.8 ± 5.4 mm) occurred when posi-tioned in 30° adduction from 90° of hip and knee flexion followed by 45° internal rotation from neutral flexion/extension (SP: 22.2 ± 5.9 mm; IP: 20.6 ± 5.3 mm; SG: 17.4 ± 3.0 mm) and 45° external rotation with 90° hip and knee flexion (SP: 19.4 ± 10.2 mm; IP: 10.4 ± 7.8 mm; SG: 9.4 ± 7.0 mm). The OI (18.2 ± 7.7 mm) and IG (15.5 ± 3.3 mm) had the greatest length change with 45° internal rotation from neutral flexion/extension followed closely by 30° adduction from 90° of hip and knee flexion (OI: 17.1 ± 6.0 mm; IG: 14.7 ± 7.2 mm). The supine piriformis stretch caused the least amount of length change for any of the muscles, (P<.05).CONCLUSIONS: While all stretch positions caused a length change for the deep rotators of the hip, the 3 stretch positions that caused the greatest change were: (1) 30° adduction from 90° of hip and knee flexion, (2) 45° internal rotation from neutral flexion/extension, and (3) 45° external ro-tation with 90° hip and knee flexion.CLINICAL RELEVANCE: Clinicians may apply the results of this study to select positions to effectively stretch the deep rotators of the hip. The piriformis and superior gemellus had a larger change in length when adducting the hip from 90° of hip and knee flexion. The obturator internus and inferi-or gemellus had a greater length change when internally rotating the hip from neutral flexion/extension.

OPO149THE ACCURACY OF 3 CLINICAL TESTS IN DIAGNOSING PROXIMAL HAMSTRING PATHOLOGYRyan P. McGovern, RobRoy L. Martin, Ricardo G. Schroder, Hal D. MartinHip Preservation Center, Baylor University Medical Center, Dallas, Texas; RSHS Graduate Program, Duquesne University, Pittsburgh, Pennsylvania; Physical Therapy, Duquesne University, Pittsburgh, PennsylvaniaPURPOSE/HYPOTHESIS: Studies are needed to investigate the clinical use-fulness of tests for individuals with nonarthritic hip pain. The purpose of this study was to define the diagnostic accuracy of 3 tests in identifying individuals with proximal hamstring pathology.NUMBER OF SUBJECTS: Forty subjects (30 female, 10 male).MATERIALS/METHODS: Clinical records of individuals who underwent a physical examination, magnetic resonance imaging (MRI) and injection testing of the hip region due to posterior hip pain were retrospectively re-viewed. A routine clinical examination was performed on each subject that included the active hamstring tests at 30° and 90°as well as noting pain at heel strike during gait. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculat-ed for each test.RESULTS: Subjects had a mean ± SD age of 48 ± 16.7 years (range, 15-71 years) and reported a mean ± SD symptom duration of 39 ± 39.3 days (range, 3-120 days). Using MRI imaging and injection testing as the gold standard, 26 out 40 (65%) were diagnosed and treated for proximal ham-string pathology. The sensitivity, specificity, positive likelihood ratio, neg-ative likelihood ratio, and diagnostic odds ratio for the active hamstring test at 30° knee flexion were 0.72, 0.97, 21.7, 0.29, and 75.4, respective-ly. For the active hamstring test at 90° flexion, sensitivity, specificity, pos-itive likelihood ratio, negative likelihood ratio, and diagnostic odds ra-tio values were 0.61, 0.97, 18.3, 0.40, and 45.6, respectively. For walking heel strike pain, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio values were 0.54, 0.71, 1.88, 0.65, and 2.92, respectively. The most accurate findings were obtained when the results of the active hamstring tests at 30° and 90° were com-bined with sensitivity, specificity, positive likelihood ratio, negative like-lihood ratio, and diagnostic odds ratio values of 0.83, 0.97, 25, 0.17, and 145, respectively.CONCLUSIONS: The active hamstring tests at 30° and 90° of knee flexion

mining pain type in an outpatient clinical practice setting.NUMBER OF SUBJECTS: Two licensed physical therapists utilized the PCT to assist in the identification of pain type in 228 patients who were referred to an outpatient orthopaedic physical therapy clinic with complaints of musculoskeletal pain.MATERIALS/METHODS: The PCT included 32 criteria that defined symptom nature, duration, behavior, and severity in addition to physical signs and patient beliefs. The criteria were divided into 1 of 3 categories (NP, PNP, CS) based on best evidence and the current understanding of neurophysi-ology. The criteria were designed as a checklist. There were 8 criteria sug-gestive of NP, 5 criteria suggestive of PNP, and 9 criteria suggestive of CS. After completing the patient examination, the therapist would utilize the PCT to determine the patient’s primary pain classification indicating the corresponding criteria present.RESULTS: Utilizing the PCT, 157 patients were identified as NP (69%). An average of 4.5 criteria were identified as present with the most common being positive pain provocation testing, aggravation of pain symptoms with movement or loading, localized pain presentation pattern, and the absence of neurogenic descriptors. A total of 57 patients were identified as PNP (25%). An average of 3.3 criteria were identified as present with the most common being positive neural tension testing and the presence of neurogenic pain descriptors. A total of 14 patients were identified as CS (6%). An average of 7.7 criteria were identified as present with the most common being greater than 3 months in duration of symptoms, re-port of decreased quality of life, and qualifying scores on selected pain questionnaires.CONCLUSIONS: This pilot study provides support for the use of the PCT in clinical practice to guide classification of pain mechanisms. There was not a case in which all criteria were present nor was there a specific criterion present in all cases for the NP or PNP classifications. These findings sug-gest variability in pain reports and patient presentation indicating a clas-sification tool could be helpful to guide decision making. Further research is needed to determine the construct and criterion validity of the PCT.CLINICAL RELEVANCE: Utilization of a PCT may assist in the diagnosis of musculoskeletal pain syndromes, improve intervention selection, facili-tate patient centered plan of care development, and ultimately improve patient outcomes.

OPO148LENGTH CHANGE OF THE HIP EXTERNAL ROTATORS IN COMMON STRETCH POSITIONSRyan P. McGovern, RobRoy L. Martin, Benjamin R. KivlanPhysical Therapy, Duquesne University, Pittsburgh, PennsylvaniaPURPOSE/HYPOTHESIS: The objective of this study was to evaluate length change of the piriformis, superior gemellus, obturator internus, and infe-rior gemellus during several commonly used stretch positions.NUMBER OF SUBJECTS: Nine cadavers.MATERIALS/METHODS: Seventeen hip joints from 9 embalmed cadavers (5 male, 4 female) aged between 49 and 96 years were skeletonized, leaving only the short external rotators and joint capsule intact. Polypropylene strings were attached from the origin to insertion sites of the superior (SP) and inferior fibers (IP) of the Piriformis, Superior Gemellus (SG), Obturator Internus (OI), and Inferior Gemellus (IG) to represent the musculotendinous fibers of the short external rotators of the hip. The change of length (mm) noted by excursion of the strings when moved from the anatomical position to 4 specific stretch positions: (1) 45° inter-nal rotation from neutral flexion/extension, (2) 45° external rotation with 90° hip and knee flexion, (3) 30° adduction from 90° of hip and knee flex-ion, and (4) 30°of adduction with the limb positioned in hip and flexion with the lateral malleolus in contact with lateral femoral epicondyle of the contralateral limb (aka, supine piriformis stretch) were recorded. A MANOVA with post hoc analysis determined the effect of the stretch po-sition on the change of length of each muscle.RESULTS: There was a significant effect on length change based on the


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PURPOSE/HYPOTHESIS: Patellofemoral pain (PFP) is a common orthopae-dic condition that frequently becomes chronic in females. In other chron-ic pain conditions, reports of depression and feelings of hopelessness are reported which may reduce the efficacy of standard therapeutic exercise programs. Despite the chronic nature of PFP, treatment does not account for potential alterations in psychosocial factors, potentially limiting the effectiveness of treatment. In order to better understand the condition and begin improving treatment we sought to define the differences in re-ports of depression, kinesiophobia, pain catastrophizing, sleep quality, and level of fatigue between females with chronic PFP and control sub-jects. We hypothesized that females with chronic PFP would report sig-nificantly higher incidences of depression, kinesiophobia, pain catastro-phizing, poor sleep, and fatigue on self-reported outcome measures when compared to a control group.NUMBER OF SUBJECTS: Twenty-seven females with PFP (mean ± SD age, 25.8 ± 6.9 years; height, 1.67 ± 0.07 m; mass, 67.64 ± 10.26 kg) and 17 controls (age, 25.8 ± 6.8 years; height, 1.62 ± 0.07 m; mass, 58.25 ± 8.25 kg) were collected. For inclusion in the study, all subjects in the PFP group were required to have symptoms for at least 3 months.MATERIALS/METHODS: Participants completed the following self-report-ed outcome scales: the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), the Fatigue Severity Scale (FSS), the Pain Self Efficacy Scale (PSEQ), and the Pittsburgh Sleep Quality Index (PSQI). Additionally, the participants completed a questionnaire about their PFP history, including the primary location of pain, frequency, and duration of symptoms, and a questionnaire about their history of depres-sion/hopelessness. Independent 2-sample t tests were used to compare between groups.RESULTS: We found significant differences in the following scales: PSQI (PFP, 8.3 ± 3.7; CON, 5.5 ± 2.3; P = .003), TSK (PFP, 38.3 ± 7.3; CON, 27.1 ± 6.1; P = .00003), PCS (PFP, 9.2 ± 9.8; CON, 0.3 ± 1.4; P = .0008), FSS (PFP, 31.5 ± 11.7; CON, 18.8 ± 9.1; P = .0004), and PSEQ (PFP, 51.4 ± 8.6; CON, 59 ± 2.7; P = .001). Within the PFP group, 37% reported expe-riencing depression compared to 11% of the control group.CONCLUSIONS: Females with chronic PFP reported experiencing poorer sleep, increased fatigue, higher kinesiophobia, increased pain catastro-phization, and increased incidence of depression and feelings of hope-lessness compared to the control group. The presence of chronic PFP ap-pears to impact multiple psychosocial constructs, which may impair the efficacy of current treatment for PFP which is predominantly driven by therapeutic exercises.CLINICAL RELEVANCE: The results suggest that females with chronic PFP are more likely to be depressed, sleep poorly, and have a greater fear of mov-ing than controls. Physical therapists should consider the impact of this psychological profile on the patient’s presentation and adjust their treat-ment plans to include patient education and interventions to reduce fear of movement, depression, and pain catastrophization.

OPO152WHAT IS THE BEST TIME TO USE THE START BACK TO PREDICT CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC LOW BACK PAIN WHO RECEIVE PHYSICAL THERAPY?Flavia Medeiros, Leonardo O. Costa, Marco Aurélio N. Added, Evelyn Salomao, Luciola M. CostaMasters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, BrazilPURPOSE/HYPOTHESIS: The STarT (Subgroups Target Treatment) Back Screening Tool (SBST) is used to classify patients with low back pain into 3 risk categories of having a poor prognosis. However, this classi-fication may change over time. In addition, baseline classification does not take into account variables that can influence the prognosis during treatment or over time. This study was designed to investigate what is the best time to using the SBST to predict clinical outcomes. Specifically, we investigated (1) the changes in the risk classification measured by the

were valuable in diagnosing hamstring pathologies, while heel strike pain during gait was not useful.CLINICAL RELEVANCE: The active hamstring test should be performed at both 30° and 90° of knee flexion to be most accurate in identifying those with and without proximal hip pathology.

OPO150THE RELATIONSHIP BETWEEN CLINICALLY OBSERVED ABERRANT MOTION AND GLUTEAL STRENGTH IN YOUNG PATIENTS PRESENTING TO PHYSICAL THERAPY WITH LOW BACK PAINClaire McKeone, Mark V. PaternoCincinnati Children’s Hospital Medical Center, Cincinnati, OhioPURPOSE/HYPOTHESIS: The pathomechanical behavior of spinal instability is ambiguous and poorly defined. In order to fully understand the change in movement patterns physical therapists need to be able to define the mechanism driving the altered movement. Gluteal muscle inhibition is often present in people with low back pain, most obviously in the return from flexion. This study was designed to determine if there is a clinical-ly significant relationship between gluteal strength and aberrant motion in patients with low back pain. The tested hypothesis was the presence of impaired gluteus maximus strength would be positively correlated to the presence of aberrant motion. This hypothesis was investigated using ret-rospective data from the initial evaluations of patient with the diagno-sis of low back pain from hospital based outpatient orthopaedic physical therapy clinic from April 2015 through March 2016.NUMBER OF SUBJECTS: One hundred twelve patients.MATERIALS/METHODS: Using the OT/PT/TR Divisional Patient Registry, evaluation data were pulled for patients seen between April 2015 and March 2016 for a spine evaluation. The data were sorted to determine which patients had values entered for both presence of aberrant motion and a MMT grade for gluteus maximus strength. There were 112 patients (mean ± SD age, 16.1 ± 5.0 years) who met this criteria. For the purpose of this study patients’ who had “Within Functional Limits” or “Within Normal Limits” recorded for their strength values were not included. In addition for this study painful arc of movement was not considered aber-rant motion. Chi-square analysis was used to determine the association between gluteal muscle strength and the presence of aberrant motion.RESULTS: Twenty of 112 patients presented with 5/5 strength of which, 80% (16/20) had aberrant motion. 72/112 patients had 4/5 strength, 82% (59/72) presented with aberrant motion. 20/112 patients had 3/5 strength, 85% (17/20) had aberrant motion. Chi-square analysis suggest-ed no significant difference in the proportion of patients who present with aberrant motion within each with gluteal muscle strength classification (3, 4 or 5). Approximately 80% to 85% of all patients with LBP presented with aberrant motion, regardless of glut max strength.CONCLUSIONS: These finding support the null hypothesis that there is no evident correlation between gluteus maximus strength and aberrant mo-tion. Further investigation is needed to determine if there is an objective measure that correlates with the presence of aberrant motion.CLINICAL RELEVANCE: There is lack of valid assessments for instability and the clinical prediction rule for lumbar instability has questionable valid-ity in this population. Further research needs to be done to determine the underlying factors that influence aberrant motion. Though gluteal strength is impaired in the low back pain population it does not appear to have a clinically significant relationship to aberrant motion.

OPO151MORE THAN KNEE PAIN: FEMALES WITH CHRONIC PATELLOFEMORAL PAIN DEMONSTRATE ALTERED PSYCHOSOCIAL RESPONSESRachelle McKinley, Kaley Robertson, Paul Kline, Brian NoehrenDepartment of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky; Division of Physical Therapy, University of Kentucky, Lexington, Kentucky


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MATERIALS/METHODS: The subjects attended 2 sessions that were 2 to 3 days apart. In each session, 2 therapists (1 experienced and 1 novice) used pisiform grip to apply central lumbar mobilization to the fourth lumber vertebrae (L4) of the subject’s spine. The therapists fixed the IMU and 1 Optoptrak marker on their bottom hand, and stood on a force plate to ap-ply the mobilization at a constant maximum force of 200 N with 4 differ-ent amplitudes (30, 60, 90, and 120 N). The LabVIEW program was used to provide live visual feedback to the therapists about the amount of mo-bilization forces. The validity of IMU was tested by comparing the mea-surements of IMU to the standard measures of mobilization (force plate and Optotrak motion capture system). The reliability of IMU was test-ed in term of agreement of the IMU measurements between the 2 thera-pists (interrater reliability) and between 2 sessions (intrarater reliability).RESULTS: Results show that the measurements of IMU had high corre-lation with force plate (Spearman rho >0.90) and high agreement with the Optotrak (percent measurement error, percentage less than 15%). Furthermore, there was high agreement between the IMU measurements between sessions and therapists (both percents less than or equal to 5%).CONCLUSIONS: We show that IMU is a valid and a reliable device to mea-sure the amplitude of the therapist’s hand movement during lumbar mobilization.CLINICAL RELEVANCE: IMU is portable and inexpensive device that can be used in the clinic. The use of IMU may increase consistency in applying mobili-zation and ultimately improve patient outcomes. Furthermore, the mobili-zation measures from IMU can be used in future to give feedback to phys-ical therapy students while they are learning and practicing mobilization.

OPO154IS ANKLE TAPING AN APPROPRIATE INTERVENTION FOR PREVENTING LATERAL ANKLE SPRAINS? A SYSTEMATIC REVIEWAlicia B. Messer, Tarang K. JainPhysical Therapy and Athletic Training, Northern Arizona University, Flagstaff, ArizonaPURPOSE/HYPOTHESIS: The ankle joint is one of the most injured joints in people participating in sports, representing up to 45% of all sports in-juries and accounting for the most musculoskeletal injuries seen in the emergency department [1,2,3]. Approximately 85% of these ankle inju-ries are due to an inversion injury involving lateral ligament damage [4]. It is estimated that half of the general population sustains at least 1 an-kle sprain during their life and as many as 55% of them do not seek inju-ry treatment from a health care professional [5,6]. Furthermore, an ini-tial ankle sprain leads to high rate of injury recurrence and can lead to chronic ankle instability, causing long term disability and degeneration [7,8]. For many years, providers have relied on ankle taping to reduce the risk of re-injury following an initial lateral acute sprain; however, the cur-rent evidence to support the use and effectiveness of prophylactic taping is unclear. The purpose of this systematic review was to evaluate the cur-rent evidence on the use of prophylactic taping use for reducing the risk of acute and recurrent lateral ankle sprains.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: To conduct this systematic review, we used the ba-sic search index using the combination of keywords “Taping” and “Ankle sprain” and restricted MeSH terminology to MeSH major topics, includ-ing functional ankle instability, chronic ankle instability, biomechan-ics, kinematics, and injury as subheadings. PubMed, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) da-tabases were searched for studies that were randomized-controlled trial (RCT), published in English language, utilized human subjects, and used at least 1 ankle taping intervention.RESULTS: Our initial review yielded 64 RCTs. After applying the screen-ing criteria, 8 studies were analyzed using Sackett’s levels of evidence and were examined for scientific rigor.CONCLUSIONS: The results suggested that ankle taping has no significant effect on preventing acute and recurrent ankle sprains in people with or

SBST over a period of 6 months and (2) the long-term predictive ability of the SBST when applied at different time points in Brazilian patients with chronic low back pain who have received a standardized physical therapy treatment.NUMBER OF SUBJECTS: One hundred forty-eight.MATERIALS/METHODS: This is a 6-month prospective cohort study nested into an existing randomised controlled trial. Were included patients with chronic nonspecific low back pain, of both sexes, aged between 18 and 80 years and who were seeking physical therapy treatment. Clinical out-comes of pain intensity, disability and global perceived effect as well as SBST were collected at baseline, after 5 weeks, 3 and 6 months. All pa-tients received 10 sessions of physiotherapy based on general and spe-cific exercises for low back pain and manual therapy. Three categories were created to evaluate the changes in the SBST subgroups, following the same categorization proposed by Beneciuk (improved, worsened, sta-ble). Changes in SBST subgroups were calculated using descriptive statis-tics. Linear regression models were built to analyze the predictive ability of SBST when applied at different points of time.RESULTS: After receiving good quality physiotherapy care, 60.8% changed their risk classification (54.7% improved the risk). The subgroup with the highest percentage of change (75%) was the medium risk. The SBST im-proved the prediction of disability, pain intensity and global perceived ef-fect at 5 weeks, 3 months and changes from 5 weeks to baseline, after con-trolling for potential confounders (sex, age, duration of symptoms and the total score of the outcome at baseline). The SBST at baseline did not im-prove the predictive ability of the models after adjusting for confounding.CONCLUSIONS: This study confirms partially the findings from Beneciuk et al 2014 showing that many patients change their risk subgroup after re-ceived physiotherapy care. The predictive ability of the SBST in patients with chronic low back pain increases when applied in different time points, especially after treatment and after 3 months.CLINICAL RELEVANCE: Our results show the utility of the SBST for predicting the prognosis of patients who seek physical therapy treatment. Although the SBST at baseline does not add predictive information when controlled for confounding, the SBST is useful when applied after treatment.

OPO153MEASURING LUMBAR MOBILIZATION WITH INERTIAL MEASUREMENT UNITFahed Mehyar, Sara Wilson, Vincent S. Staggs, Kosaku Aoyagi, Neena K. SharmaPhysical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas; Mechanical Engineering, University of Kansas, Lawrence, Kansas; Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, and School of Medicine, University of Missouri, Kansas City, MissouriPURPOSE/HYPOTHESIS: Lumbar mobilization is a standard assessment and treatment method. However, there is inconsistency in the amount of forc-es applied by clinicians during the mobilization. Optical motion capture systems and force measuring devices (eg, force plates) have been used in research laboratories to measure the movements and forces of mobiliza-tion. However, these devices are not available in clinical practice. A prac-tical and indirect method of measuring mobilization in clinical practice is to measure the therapist’s hand motion during mobilization. Inertial Measurement Unit (IMU) is a small and inexpensive device that can be used to measure the oscillatory movements (amplitude) of the therapist’s hand during mobilization. IMU consists of an accelerometer and gyro-scope that allows for measurement of acceleration and angular veloci-ty. The amplitude of the therapist’s hand displacement can be calculat-ed from the acceleration and angular velocity using integration methods and geometric equations. This study investigates the validity and reliabili-ty of IMU in measuring the amplitude (oscillation) of the therapist’s hand movement during lumbar mobilization.NUMBER OF SUBJECTS: Sixteen healthy subjects with no low back pain for the last 6 months.


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with current best practice.

OPO156RELIABILITY OF ICD-10 CODING OF LOW BACK CONDITIONS BY PHYSICAL THERAPISTSMarcia A. Miller Spoto, Andrew J. Opett, John Bulawa, Abbie Carey, Ryan Downey, Martin Hoogendijk, Marsden E. JamieHealth Science and Physical Therapy, Nazareth College, Rochester, New YorkPURPOSE/HYPOTHESIS: Physical therapists in contemporary practice are re-sponsible for assigning International Classification of Disease (ICD)-10 codes to musculoskeletal conditions that fall within their scope of prac-tice. The reliability of assigning ICD codes is important in health care for reasons that include: appropriate categorization of health conditions for statistical purposes, communication with third party payers, to inform prognosis, and to direct treatment. Yet, little is known about the reliability among physical therapists in assigning ICD-10 codes to these health con-ditions. As the role of the physical therapist as a primary health care pro-vider for musculoskeletal conditions evolves, it will become increasingly important for clinicians to assign ICD-10 codes in a consistent manner. The purpose of the present research is to determine the interrater reliabil-ity among physical therapists in assigning ICD-10 codes to musculoskel-etal conditions of the low back.NUMBER OF SUBJECTS: Participants consisted of 12 orthopaedic certified specialists (OCS) practitioners, with representation of all major geo-graphic regions in the United States.MATERIALS/METHODS: Using electronic medical records of patients treated in Rochester, NY outpatient orthopaedic clinics, 10 Low Back Pain pa-per cases were created. The paper cases described both historical data, and physical examination findings. Participants were provided a list of relevant ICD-10 codes for lumbar spine conditions and asked to assign the most appropriate code to each of 10 cases based on their clinical judgment. Pairwise comparisons were determined. Interrater reliability among participants was determined by analyzing overall percent agree-ment and Cohen’s kappa using SPSS with 95% confidence intervals.RESULTS: There were a total of 660 classification judgments utilized in the analysis of reliability. Percent agreement among raters was 28.64%; kappa was 0.1768, which makes overall intertester reliability slight. Greater inter-rater agreement was found when using 4-digit codes as compared to 5-dig-it codes. The most frequently assigned code was M54.5 (low back pain).CONCLUSIONS: These findings are consistent with other studies that have demonstrated poor reliability in assigning ICD-10 codes in primary care. Overall agreement was not much better than what may have occurred strictly due to chance.CLINICAL RELEVANCE: The ICD is a universal disease classification system. There is currently limited evidence on reliability of physical therapists as-signing ICD-10 codes. This study raises questions about how physical ther-apists and other health care providers are engaging in clinical decision making in diagnostic classification. Future studies should explore code as-signment by health care practitioners across all musculoskeletal conditions.

OPO157THE USE OF MIRROR THERAPY AND CROSS-EDUCATION TO TREAT CHRONIC PAIN AND WEAKNESS 9 MONTHS POSTOPERATIVE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A CASE REPORTChelsea A. Miller, Deanna Perchiano, Erin Podracky, Lacey Scrima, Yvan Trinh, Marlon L. WongPhysical Therapy, University of Miami, Miami, FloridaBACKGROUND AND PURPOSE: Traditional post-ACLR rehabilitation pro-tocols advocate for a criterion-based progression program, which uses milestones pertaining to strength, ROM, and functional capabilities to determine advancement [1,2]. However, a percentage of patients experi-ence complications following ACL surgery, such as arthrofibrosis, and do

without the history of ankle sprains. Ankle taping may affect the avail-able range of motion at the ankle joint, and its effect on proprioception is debatable. A qualitative analysis suggested all included studies met at least 4 of 7 applied criteria with only 1 study meeting 6 of 7 criteria. Our review found ankle bracing to be more cost-effective and beneficial than ankle taping in reducing long-term risk of reinjury. There is a need for more well-designed and well-controlled RCTs to evaluate the effect of an-kle taping on the incidence of acute and recurrent lateral ankle sprains. There is limited evidence to support the use of prophylactic ankle taping for reducing the risk of lateral ankle sprains in people with or without the history of ankle sprains.CLINICAL RELEVANCE: Based on available evidence, health care profession-als should consider using prophylactic bracing over prophylactic taping to prevent lateral ankle sprains.

OPO155IMPACT OF A 24-HOUR EDUCATIONAL PROGRAM FOR CONSERVATIVE PRIMARY CARE PRACTITIONERS ON ATTITUDES AND BELIEFS ABOUT SPINE PAIN MANAGEMENTMarcia A. Miller SpotoHealth Science and Physical Therapy, Nazareth College, Rochester, New YorkPURPOSE/HYPOTHESIS: There is increased recognition that health condi-tions represent complex interactions of biological, psychological and so-ciological factors. The biopsychosocial (BPS) model represents a para-digm shift in health care, superseding the biomedical framework in the diagnosis and treatment of health conditions. Nowhere is this more im-portant than in the management of spine pain. Many health care provid-ers, however, including conservative providers such as physical therapists (PTs) and chiropractors (DCs), are acculturated in the biomedical mod-el through formal education. As conservative providers move toward as-suming primary care roles for spine related problems, their orientation to the BPS model of care is essential. The purpose of this study is to investi-gate the impact of a 24-hour spine pain management program on the rel-ative orientation of conservative care providers to biomedical versus BPS approaches to care.NUMBER OF SUBJECTS: Participants included a total of 70 PTs and DCs at-tending the Excellus BC/BS spine care pathway (SCP) education program in upstate NY.MATERIALS/METHODS: The SCP program is evidence-based, spine manage-ment education designed to prepare PTs and DCs as primary spine prac-titioners. The Patient Attitudes and Beliefs Scale (PABS) was utilized to measure the relative orientation of participants toward the biomedical and BPS models of care. The tool was administered at the beginning of the 4-day program, and immediately following the program. There were 2 cohorts: 50 participants completed the program in the fall of 2015, 20 participants completed the program in the spring of 2016. Simple t tests were used to compare pre and postprogram scores on both the biomedi-cal and BPS subscales of the PABS.RESULTS: Combined scores for both cohorts are reported. Pre and post-test biomedical subscales were 54% and 45.2%, respectively. Pretest and posttest BPS subscales were 57.6% and 59.9% respectively. The decrease in biomedical scores and increase in BPS scores were statistically signif-icant (P<.05).CONCLUSIONS: A 4-day spine management program based upon the BPS model of care impacts the relative orientation of health care providers to-ward the biomedical and BPS models of care; providers demonstrate a shift in their orientation in favor of the BPS model of care.CLINICAL RELEVANCE: Clinical guidelines for neck and back pain consistent-ly support a BPS approach to patient management. Healthcare provider attitudes and beliefs toward spine pain influence clinical decision-mak-ing, and therefore adherence to evidence-based practice. As physical ther-apists and other conservative providers evolve in their roles as primary spine practitioners, it is important that their clinical behaviors are aligned


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2014;7:451-459. 10. Tsao H, Danneels LA, Hodges PW. ISSLS prize win-ner: smudging the motor brain in young adults with recurrent low back pain. Spine (Phila Pa 1976). 2011;36:1721-1727.

OPO158THE ASSOCIATION BETWEEN DEEP NECK FLEXOR ENDURANCE AND DESKTOP COMPUTING POSTURES IN COLLEGE STUDENTSAndi Beth Mincer, Taylor Benton, Hawley Emanuele, Stefanie Ortiz, Molly Rush, David Bringman, Haley S. WorstRehabilitation Sciences, Armstrong State University, Savannah, GeorgiaPURPOSE/HYPOTHESIS: Neck pain is common during prolonged comput-er use, and has been associated with impaired endurance of the deep neck flexors (DNF). This study attempted to: describe patterns of desk-top computing postures; assess the relationship between DNF endurance and these postures; compile reports of computer use from college stu-dents; and assess for a ceiling effect in the Craniocervical Flexion Test (CCFT). Our main hypothesis was that there would be a relationship be-tween DNF endurance and desktop computing postures.NUMBER OF SUBJECTS: Survey data were collected and combined from 2 separate trials with 118 undergraduate and graduate student participants with or without neck pain. In the most current of these trials, CCFT test-ing and video analysis of a prolonged desktop computing task was also conducted in 53 of these (18 male, 35 female) participants.MATERIALS/METHODS: The final phase of the CCFT (30 mmHg) was extend-ed from 3 to 10 repetitions for each subject to allow assessment for a ceil-ing effect in traditional CCFT testing. Video recordings of subjects engag-ing in 30-minute desktop computer tasks were qualitatively assessed to identify patterns of postures and these were analyzed with CCFT results. During computing, subjects completed a survey of neck symptoms and computer use. Subjects repeated a similar computer task within 1 week to analyze for consistency. Subjects were blind to the video recording, and researchers were blind to results of CCFT and video analysis.RESULTS: Descriptive statistics compiled on computing habits revealed that students use laptops far more frequently than desktops, and they use a computer more than 7 hours daily for school, work and personal tasks. Qualitative analysis revealed several ranked patterns of trunk and neck postures during desktop computing. These sitting behaviors differed for the mouse and keyboard phases of computing, but behavior during each of these phases was very consistent across sessions. The standard CCFT is sensitive and does not exhibit a significant ceiling effect, even in young adults. There was no significant statistical relationship between DNF en-durance and either computer use patterns or computing postures.CONCLUSIONS: This mixed methods study is the first to categorize and rank postures during computing. This is the first step in establishing relation-ships between these postures and other musculoskeletal factors, such as DNF endurance. The results of this study demonstrate that college stu-dents exhibit certain patterns of desktop computing postures, but these do not appear to relate to neck muscle endurance. Future analysis of lap-top computing postures is warranted since students use laptop comput-ers almost exclusively.CLINICAL RELEVANCE: The relationship between neck pain, computer pos-tures, and deep neck flexor endurance is still unclear but warrants further exploration since neck pain has been correlated to both poor computer er-gonomics and poor DNF endurance.

OPO159CONSIDERATIONS FOR DRY NEEDLING THE LEVATOR SCAPULAE/UPPER TRAPEZIUSUlrike H. Mitchell, Aaron W. JohnsonExercise Sciences, Brigham Young University, Provo, UtahPURPOSE/HYPOTHESIS: One complication associated with dry needling (DN) is the inadvertent piercing of the pleura that holds the lungs to the inside of the chest wall, which can lead to lung collapse. While it is com-

not respond well to these traditional rehab approaches [1,3-6]. This case study describes the rationale and outcomes of an alternate treatment ap-proach, using the concepts of cross-education and the mirror neuron sys-tem, for a patient with chronic pain and weakness 9 months post-ACLR.CASE DESCRIPTION: The patient was an active 24-year-old who received ACLR with patellar autograft 8 months after initial injury, but required a second arthroscopic procedure to address arthrofibrosis. She received 5 months of standard rehabilitation, with continued limitations noted with range of motion, quadriceps strength, gait mechanics, and functional mo-bility. Due to the poor response to a traditional protocol, the patient was then enrolled in a mirror therapy program at 3 times a week for 8 weeks. Five exercises were performed each session using the uninvolved limb only. A mirror was placed between the 2 limbs, reflecting the uninvolved limb to the space overlying the involved limb.OUTCOMES: Biodex testing on the involved lower extremity demonstrated improved peak isometric knee extension torque from 38.5 ft-lb to 68.2 ft-lb Isokinetic peak extension torque improved from 27.9 ft-lb to 39.9 ft-lb and total work produced from 402.1 ft-lb to 669.4 ft-lb at 300°/s. Single-leg anterior reach increased from 48 cm to 57.2 cm and single-leg sit to stand increasing from 20 to 30 repetitions. Limb symmetry index of the above measures trended towards improved symmetry throughout the study. Girth measurements remained relatively unchanged on the in-volved limb. The patient’s Knee injury and Osteoarthritis Outcome Score (KOOS) gradually declined throughout the study, with changes from ini-tial to final measurement as follows: Symptoms 46.5 to 36, Pain 72.3 to 59, ADL 96 to 88.3, Sport/recreation 60 to 45, and Quality of Life 69 to 44. Self-reported pain scores peaked during the midpoint of the study, correlating with an increase in the patient’s activity levels at that time.DISCUSSION: A top-down treatment approach was incorporated in this case study, through cross-education and activation of the mirror neuron sys-tem, with goals of effecting motor control through cortical activation [7-10]. It is likely that this patient’s self-reported disability trended more closely to her pain levels than her performance on strength and function-al measures, explaining the decline in KOOS scores. The gains in strength were likely due to cortical and neuromuscular adaptations since quadri-ceps girth was relatively unchanged. This case demonstrates the potential utility of mirror therapy to improve strength and performance in patients with chronic pain and weakness post-ACLR.REFERENCES: 1. Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament re-construction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42:601-614. 2. Myer GD, Paterno MV, Ford KR, Quatman CE, Hewett TE. Rehabilitation after anterior cruciate liga-ment reconstruction: criteria-based progression through the return-to-sport phase. J Orthop Sports Phys Ther. 2006;36:385-402. 3. Skutek M, Elsner HA, Slateva K, et al. Screening for arthrofibrosis after ante-rior cruciate ligament reconstruction: analysis of association with hu-man leukocyte antigen. Arthroscopy. 2004;20:469-473. 4. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. 2009;91:2321-2328. 5. Mayears HO, Weig TG, Plitz W. Arthrofibrosis following ACL reconstruc-tion--reasons and outcome. Arch Orthop Trauma Surg. 2004;124:518-522. 6. Said S, Christainsen SE, Faunoe P, Lund B, Lind M. Outcome of surgical treatment of arthrofibrosis following ligament reconstruc-tion. Knee Surg Sports Traumatol Arthrosc. 2011;19:1704-1708. 7. Foell J, Bekrater-Bodmann R, Diers M, Flor H. Mirror therapy for phantom limb pain: brain changes and the role of body representation. Eur J Pain. 2014;18:729-739. 8. Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the motor cortex is related to the severity of low back pain. Spine (Phila Pa 1976). 2015. 9. Schabrun SM, Jones E, Elgueta Cancino EL, Hodges PW. Targeting chronic recurrent low back pain from the top-down and the bottom-up: a combined transcranial direct current stim-ulation and peripheral electrical stimulation intervention. Brain Stim.


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fraspinatus muscle and a 75% external rotation strength deficit. A mus-culoskeletal ultrasound imaging exam was performed by an experienced orthopaedic physical therapist using a Supersonic Imagine with a HFL 15-MHz probe. With the subject prone, the infraspinatus muscle belly and tendon, posterior glenohumeral joint, spinoglenoid notch were im-aged in long axis directly along the fibers of the infraspinatus muscle with the probe oriented inferior and parallel to the spine of the scapula. Poor definition and heterogeneity of the internal architecture of the infraspi-natus muscle compared to normal appearing deltoid muscle overlying it as well as the supraspinatus suggested atrophy associated with denerva-tion or rotator cuff tear. Dynamic MSK US further revealed an absence of muscle thickness changes during active abduction and external rota-tion resistance testing as compared to the contralateral shoulder. Reduced muscle bulk in addition to the echogenic changes to the internal archi-tecture of the infraspinatus muscle suggested atrophy associated with denervation.DISCUSSION: MSK US revealed information not present in the clinical ex-amination. Architectural changes in the infraspinatus muscle were con-sistent with denervation atrophy, not rotator cuff tear nor disuse, and was subsequently confirmed with EMG testing. The normal appearance of the supraspinatus muscle suggested that a suprascapular nerve lesion oc-curred distal to the innervation of the supraspinatus muscle. These MSK US findings helped guide the prognosis for the patient’s recovery and helped better define the nature of the patient’s symptoms of weakness and fatigue with upper extremity exercises.REFERENCES: Tragord BS, Bui-Mansfield LT, Croy T, Shaffer SW. Suprascapular neuropathy after distal clavicle resection and coraco-clavicular ligament reconstruction: a resident’s case problem. J Orthop Sports Phys Ther.. 2015;45:299-305. Sofka C, et al. Detection of muscle atrophy on routine sonography of the shoulder. J US Med. 23:1031-1034. Lesniak BP, et al. Use of ultrasound as a diagnostic and therapeutic tool in sports medicine. Arthroscopy. 2014;30:260-270. Koppenhaver S, et al. The reliability of rehabilitative ultrasound imaging in the measurement of infraspinatus muscle function in the symptomatic and asymptomatic shoulders of patients with unilateral shoulder impingement syndrome. Int J Sports Phys Ther. 2015;10:128-135. Khoury V, Cardinal E, Brassard P. Atrophy and fatty infiltration of the supraspinatus muscle: sonogra-phy versus MRI. Am J Roentgenol. 2008;190:1105-1111. Henderson REA, Walker BF, Young KJ. The accuracy of diagnostic ultrasound imaging for musculoskeletal soft tissue pathology of the extremities: a comprehen-sive review of the literature. Chiropr Man Ther. 2015;23:31. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. Am J Roentgenol. 2009;192:1701-1707.

OPO161DIAGNOSTIC ACCURACY OF THE SCAPULAR RETRACTION MANEUVER IN ASSESSING THE STATUS OF THE ROTATOR CUFFEdward P. Mulligan, Tara Dickson, Michael KhazzamDepartment of Physical Therapy, UT Southwestern Medical Center School of Health Professions, Euless, Texas; Orthopaedic Surgery, UT Southwestern, Dallas, TexasPURPOSE/HYPOTHESIS: Currently there are no dependable physical exam-ination maneuvers that can clinically diagnosis the status of the rotator cuff. The purpose of this study is to evaluate the diagnostic accuracy of the scapular retraction maneuver (SRT) to predict the status of the ro-tator cuff (RC).NUMBER OF SUBJECTS: Three hundred ninety-one subjects were prospec-tively assessed by clinical examination during initial presentation for a painful shoulder complaint.MATERIALS/METHODS: As part of the physical examination the SRT was per-formed to gauge the status of the RC. Magnetic resonance imaging (MRI) examination was used as the reference standard to confirm the status of the RC (intact or torn). The examiner was blinded to the results until after

monly known that the lung tissue is hidden beneath the ribs, it is less well appreciated how far superiorly it reaches. Being able to estimate the dis-tance from skin to the pleura and not inserting the needle any further than that estimate might lower the chances of harming the lung tissue. Therefore, the purpose of this study was to measure, with diagnostic ul-trasound, the distance from skin to pleura at the level of levator scapulae, with the subject in 2 different prone positions. We assessed for differences by stratifying the subjects by body composition and sex.NUMBER OF SUBJECTS: Thirty.MATERIALS/METHODS: Thirty college-aged subjects were measured for weight and height. For all ultrasound measurements the subject lay prone on a treatment table with the arms positioned along the trunk, head non-rotated and slightly lowered. The spinous processes of T1 and T2 were marked as were the vertebral borders and superior angles of both scapu-lae. With diagnostic ultrasound we visualized the levator scapulae/upper trapezius, ribs 1 and 2 and the underlying pleura, just medial to the supe-rior scapular angle. Two 4-second videos were taken and stored for later analysis. This procedure was repeated on the contralateral side and in 2 different positions, with and without towel under the shoulder.RESULTS: The average ± SD distance (right and left) from skin to the pleu-ra at the level of levator scapulae/upper trapezius was 4.1 ± 0.8 cm with-out towel and 4.6 ± 0.9 cm with towel, from skin to first rib (3.3 ± 0.7 cm and 3.7 ± 0.8 cm) and skin to second rib (2.9 ± 0.7 cm and 3.4 ± 0.7 cm), respectively; the difference between the 2 positions was highly significant (P< .0001). Body composition: distances from skin to pleura, skin to rib 1 and skin to rib 2 were all significantly different between subjects with BMI less than 25 compared to subjects with BMI greater than 25 kg/m2, regardless of position (P values between .02 and .004). Sex: distanc-es from skin to pleura and skin to ribs 1 and 2 were all significantly dif-ferent between women and men regardless of position (P values between .001 and .02).CONCLUSIONS: (1) When performing DN to the levator scapulae/upper tra-pezius it is safer to put a towel underneath the shoulder, because it in-creases the distance between skin and pleura by about 0.5 cm; (2) the higher the subject’s BMI, the greater the distance from skin to pleura and chest wall; and (3) women have on average significantly smaller distanc-es from skin to the pleura at the level of levator scapulae/upper trapezius.CLINICAL RELEVANCE: Physical therapists who undergo DN training have to demonstrate in-depth knowledge of the anatomy. They are being taught needle technique-related skills that are crucial to minimize the danger of inflicting harm. The results of this study underscore the importance of proper positioning of each patient as well as the need to consider their body constitution and sex.

OPO160USE OF MUSCULOSKELETAL ULTRASOUND IMAGING TO AID IN THE DIAGNOSIS OF SUPRASCAPULAR NEUROPATHY: A CASE REPORTTracy Morel, Theodore Croy, Brad Tragord, Scott W. ShafferPhysical Therapy, Moncrief Army Community Hospital, Columbia, South Carolina; US Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TexasBACKGROUND AND PURPOSE: Shoulder dysfunction is a common reason for people to seek care from a physical therapist. The purpose of this case re-port is to examine infraspinatus muscle atrophy and the use of musculo-skeletal ultrasound (MSK US) imaging by a physical therapist to deter-mine if the appearance was similar to denervation injury, rotator cuff tear, or disuse atrophy.CASE DESCRIPTION: A 28-year-old Caucasian woman (height, 1.6 m; weight, 54.1 kg; body mass index, 21.1 kg/m2) reported directly to an outpatient physical therapy clinic complaining of right shoulder weakness with pushups and repeated overhead activities. The past surgical history was remarkable for a distal clavicle excision with a coracoclavicular ligament reconstruction 3 years prior to this encounter [1].OUTCOMES: Clinical observation revealed marked atrophy of the right in-


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0.023) between the repetitive versus sustained press-ups and the time before and after each prone press-ups strategy. There was no main ef-fect for Strategy (sustained versus repetitive press ups) (F1,30 = 1.359, P = .253; partial η2 = 0.042). There was a significant main effect for Time (be-fore versus after press-ups) (F1,30 = 140.771, P<.0001, partial η2 = 0.82). Additionally, no correlation was found between the degree of end ROM spinal extension and spinal height changes following press-ups strategies.CONCLUSIONS: Following periods of spinal loading, both repetitive and sus-tained press-ups increased spinal height. Such strategies could be used to help recover spinal height and limit the effects of spinal shrinkage as a re-sult of activities of daily living.CLINICAL RELEVANCE: Preserving spinal health is important for preventing disability associated with low back pain and nerve root compression re-sulting from spinal shrinkage. Our study supports that prone press-ups strategies could be used to assist in rehydration of the intervertebral discs and in spinal height recovery.

OPO163TEST-RETEST RELIABILITY OF THE SPORTS AND PERFORMING ARTS MODULE OF THE DISABILITIES OF THE ARM, SHOULDER AND HAND QUESTIONNAIREStephanie Muth, Daniel Bresticker, Elizabeth Dalrymple, David SnyderThomas Jefferson University, Philadelphia, Pennsylvania; Arcadia University, Glenside, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose of this study was to assess the test-re-test reliability and validity of a module of a commonly used shoulder pain questionnaire- The Sports and Performing Arts Module of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (SPAM-DASH).NUMBER OF SUBJECTS: Fifteen participants between the ages of 18 to 65 who engage in sport or play an instrument 2+ times per week participated in this study. In addition, retrospective analysis of previously collected data from 30 additional similar participants were used to assess validity. All participants had shoulder pain that impacted their participation in work, school or recreation.MATERIALS/METHODS: During visit 1, participants completed the SPAM-DASH and the Penn Shoulder Score (PSS), which was used as the gold standard to assess validity of the SPAM-DASH. After being distracted by a cognitive task, participants completed the SPAM-DASH again. The next day participants returned to re-take the SPAM-DASH. An Intraclass Correlation Coefficient (ICC) was used to determine test-retest reliabil-ity and a Pearson product-moment correlation was used to assess test validity.RESULTS: The within day reliability was excellent with an ICC of 0.935 (95% CI: 0.631, 0.982). The between day reliability was very good with an ICC of 0.890 (95% CI: 0.463, 0.968). The Pearson Correlation be-tween the PSS and SPAM-DASH was –0.428 (P = .004), indicating a fair correlation that is directionally appropriate given that the PSS measures function and the SPAM-DASH assesses disability. The minimal detect-able change (MDC) for the SPAM-DASH was calculated at both the 90% and 95% confidence intervals: MDC90, 7.02; MDC95: 1.96 × 3.01 × 1.414 = 8.34.CONCLUSIONS: The SPAM-DASH is a 4-item subset of the QuickDASH. It is a reliable tool to assess disability related to patient-specified activ-ities. Correlation to the PSS was fair but directionally appropriate, sug-gesting the SPAM-DASH may be quick and efficient alternative to the lengthy PSS.CLINICAL RELEVANCE: The SPAM-DASH provides patient-specific informa-tion, unlike the rest of the Quick-DASH or PSS. The SPAM DASH may capture information missed due to the ceiling effect of the PSS or Quick DASH for the higher functioning and more active patient. More research is needed to assess the minimal clinically important difference for the SPAM-DASH in order to better support its use in a clinical setting.

the physical exam was completed. Subjects with a diagnosis of calcific ten-dinitis, adhesive capsulitis, those with prior shoulder surgery, and gleno-humeral osteoarthritis were excluded from the study. A positive SRT was defined as restoration of strength with the scapular retracted and arm el-evated 90° in the plane of the scapula. A negative SRT was defined as con-tinued weakness (or the arm dropping). Statistical analysis was conduct-ed to assess the clinical utility of the test maneuver.RESULTS: The prevalence of full thickness RC tears in the study popula-tion was 54% (180/331). The average age of the RC tear group was 54.3 with 80 males and 100 females. There were 180 patients that had a full thickness tear confirmed on MRI. Of these 180, the scapular retraction test was negative in 147 patients and positive for the remaining 33. One hundred and fifty one subjects were diagnosed with an intact RC by MRI, 122 of which had positive SRT and 29 were negative. The average age of these subjects was 54.6 with 74 males and 77 females. The sensitivity was 81.7 (95% CI: 77.2, 85.4), specificity 80.8 (95% CI: 75.5, 85.33), accuracy of 81.2 for the SRT to diagnosis a full thickness RC tear. The positive pre-dictive value was 83.5 (95% CI: 78.9, 87.4), negative predictive value 78.7 (95% CI: 73.5, 83.1), positive likelihood ratio 4.3 (95% CI: 3.1, 5.8), neg-ative likelihood ratio 0.23 (95% CI: 0.17, 0.30), diagnostic odds ratio of 18.7 (95% CI: 10.4, 34.0), and number need to diagnose and misdiagnose of 1.8 (95% CI: 1.5, 2.2) and 4.6 (95% CI: 3.7, 5.8), respectively.CONCLUSIONS: The results of this diagnostic study indicate that the SRT is influential in identifying the status of the RC based on its likelihood ra-tios. We found that the SRT renders a moderate shift in probability for the presence or absence of an intact RC tendon(s). Continued study is under-way to determine if alternate scapular positioning has similar or different diagnostic capability in differentiating intact from full-thickness RC tears.CLINICAL RELEVANCE: Clinicians may use the SRT to provide additional clin-ical insight on the status of the RC and avoid or delay unnecessary imag-ing studies after a trial of nonoperative physical therapy rehabilitation.

OPO162CAN 5 MINUTES OF REPETITIVE PRONE PRESS-UPS AND SUSTAINED PRONE PRESS-UPS FOLLOWING A PERIOD OF SPINAL LOADING REVERSE SPINAL SHRINKAGE?Michelle M. Munster, Jean-Michel Brismee, Phillip S. Sizer, Birendra M. Madi Dewan, Kevin Browne, Stéphane SobczakTexas Tech University Health Sciences Center, Lubbock, Texas; Physical Therapy, Département d’Anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, CanadaPURPOSE/HYPOTHESIS: PURPOSE: To investigate if (1) Sustained and re-petitive prone press-ups could reverse spinal shrinkage following a period of spinal loading; (2) There was a correlation between the degree of end range of motion (ROM) spinal extension and spine height gains; and (3) Provide a baseline on how asymptomatic participants responded to sus-tained and repetitive prone press-ups as a reference for further study with participants with low back pain. Hypotheses: It was hypothesized that: (1) Spinal height would increase following both repetitive and sustained prone press-ups after a period of spinal loading. (2) Sustained prone press-ups would show a greater increase in spinal height compared to re-petitive prone press-ups after a period of spinal loading. (3) There would be a positive correlation between spinal height changes and the degree of end ROM lumbar spinal extension measured during prone press-ups.NUMBER OF SUBJECTS: Thirty-two.MATERIALS/METHODS: Forty-one healthy men and women were recruited to participate. Subjects were seated in the stadiometer for 5 minutes with a 4.5-kg weight placed on each shoulder followed by 5 minutes unloaded sitting. Spinal height was measured using a stadiometer before and after 5 minutes of the following strategies: (1) repetitive prone press-ups; or (2) sustained prone press-ups.RESULTS: Following spinal loading, subjects grew using both repetitive (mean ± SD, 4.85 ± 3.01 mm) and sustained press-ups (4.46 ± 2.57 mm). There was no significant interaction (F1,30 = 0.722, P = .402, partial η2 =


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and 3 months postsurgery with an emphasis on BM limitations as per the patient report. Her initial exam in PT was consistent with central sensi-tization with yellow flags of social withdrawal, short term work disabili-ty, and severe anxiety. A coordinated plan of care was designed during a meeting with specialists from PMR, PT, and NPsy. The purpose of this meeting was to review the patient’s electronic medical record (EMR) and gather input from all 3 disciplines, which resulted in a comprehensive BSP plan of care for the patient. All 3 specialists agreed that all interven-tions and education should be directed away from a typical BM model and encompass all aspects unique to this particular patient’s pain expe-rience. Ongoing discussion throughout the EOC continued via the EMR messaging system. PT included manual therapy, exercise, and PNSE re-garding neurophysiology of pain, central sensitization, spinal inhibition and facilitation, plasticity of the nervous system, and no reference to ana-tomical or pathoanatomical models. Homework after each session includ-ed review of concepts presented during the visit, viewing of YouTube vid-eos to reinforce education, self-massage for desensitization, and regular cardiovascular exercise at moderate intensity.OUTCOMES: The patient was seen in PT for a total of 6 visits over 9 weeks. Initial Neck Disability Index (NDI) score, numeric pain rating (NPR), and Fear Avoidance Components Scale (FACS) were 62%, 7/10, and 77%, respectively. After 2 months of PT the NDI, NPS and FACS scores were 14%, 6/10, 11%, respectively. At the time of her last PT appointment the patient had returned to training for a triathlon, full time work, and felt comfortable interacting again in social situations.DISCUSSION: As the evidence builds to support the BPS approach to chron-ic pain there is a need to further define what that approach looks like in a typical outpatient PT clinic. In this case report the use of specialists from 3 disciplines working together to reinforce the same message to the pa-tient was effective in managing the pain experience unique to this par-ticular patient.REFERENCES: Louw A, Puentedura EJ. Therapeutic Neuroscience Education, Volume 1. Minneapolis, MN: OPTP; 2013. Foster NE, Delitto A. (2011). Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management princi-ples into physical therapist practice: challenges and opportunities. Phys Ther. 2011;91:790-803. Jull G, Sterling M. Bring back the biopsychoso-cial model for neck pain disorders Man Ther. 2009;14:117-118. Linton SJ, Shaw WS. Impact of Psychological Factors in the Experience of Pain. Phys Ther. 2011;5:700-711. Nijs J, Roussel N, van Wilgen CP, Koke A, Smeets R. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying ef-fective treatment. Man Ther. 2012. Gatchel RJ, Neblett R, Kishino N, Ray CT. Fear-avoidance beliefs and chronic pain. J Orthop Sports Phys Ther. 2016;46:38-43.

OPO166DOES MEETING THE CLINICAL PREDICTION RULE FOR STABILIZATION PREDICT SUCCESS IN PATIENTS TREATED WITH LUMBAR STABILIZATION? A RETROSPECTIVE REVIEWDarren Neeley, Kate Minick, Gerard P. BrennanIntermountain Healthcare, Murray, UtahPURPOSE/HYPOTHESIS: Hicks et al outlined a clinical prediction rule (CPR) for patients who should respond favorably to stabilization exercises. The CPR included 4 criteria (1) age less than 41 years; (2) positive aberrant movements; (3) straight leg raise greater than 90°; and (4) positive prone instability test (PIT). This CPR has been included as a subgroup in the treatment based classification (TBC) for low back pain (LBP). The pur-pose of this retrospective review was to determine the extent of improve-ment in patients who met varying levels of the stabilization CPR.NUMBER OF SUBJECTS: Four hundred sixty-two.MATERIALS/METHODS: Charts were reviewed for 462 patients seen in 12 sep-arate hospital based outpatient clinics by 39 different therapists through-out the Salt Lake City area. Data were collected regarding which stabili-

OPO164EFFECTS OF HIGH-INTENSITY EXERCISE ON CENTRAL NEURAL DRIVE IN HEALTHY POPULATIONSStephanie Muth, Nicholas LeGrand, Kyearsa Robb, Emily Slobodian, Nicole Weaknecht, Megan WoodThomas Jefferson University, Philadelphia, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose of this systematic review was to exam-ine the effects of high intensity strength training (HIST) on central neu-ral drive. For this review of literature, HIST was defined as greater than 75% of maximal volitional contraction (MVC).NUMBER OF SUBJECTS: Five RCTs (n = 94 healthy subjects) were evaluated. These studies investigated high intensity strength training and changes in central neural drive. All studies compared a training group and control group. Sample sizes ranged from 14 to 23 participants. The age of partici-pants ranged from 18 to 35 years old.MATERIALS/METHODS: Five databases were used in primary searches: Ovid, PubMed, CINAHL, Cochrane, Scopus. Searches were performed using the following terms: “motor drive and exercise,” “motor evoked potential and exercise,” “voluntary activation and exercise,” “motor drive and high intensity,” “voluntary activation and high intensity,” “ motor evoked poten-tial and high intensity.” Additional information was solicited from 1 pri-mary source via email. The initial search yielded 1692 articles. Multiple levels of review yielded 10 articles which were critically appraised. Five articles were included in the final review. These 5 articles were rated for study design quality using the MacDermid Score.RESULTS: Methodological quality MacDermid quality scores ranged from 28 to 34 out of 48. Effects of HIST All studies demonstrated significant increases in strength with short-term HIST. Participants demonstrated increased voluntary activation and/or increased cortical excitability with minimal or no hypertrophy, indicating neural mechanisms rather than morphological changes (ie hypertrophy, hyperplagia, etc) were, at least in part, responsible for increases in strength.CONCLUSIONS: This review of the literature found evidence for increases in central neural drive due to HIST. Neural adaptations to HIST occurred rapidly and strength gains were seen across a range of muscles groups with both eccentric and concentric muscle training.CLINICAL RELEVANCE: There are a variety of potential clinical applications supported by the findings of this review. Patients with an inability to ef-fectively train both sides of the body due to immobilization, may benefit from neurologic overflow into the immobilized side when the unaffected side is trained. It may also be possible to capitalize on the rapid cortical adaptations in patients that need strength gains in a limited time frame, for instance preoperatively.

OPO165CHRONIC LEFT ARM PAIN POST–C5-7 ANTERIOR CERVICAL DISC FUSION MANAGED WITH A BIOPSYCHOSOCIAL MULTIDISCIPLINARY TEAM APPROACH AND PAIN NEUROSCIENCE EDUCATIONDarren Neeley, Kate MinickIntermountain Healthcare, Murray, UtahBACKGROUND AND PURPOSE: The biomedical (BM) approach to chronic pain is widely acknowledged as inadequate and results in subpar outcomes compared to a comprehensive biopsychosocial (BPS) approach. However, there is a significant gap between this knowledge and its clinical applica-tion. The purpose of this case report is to outline an episode of care (EOC) for a patient status post C5-7 anterior cervical disc fusion (ACDF) with left arm pain for greater than 1 year who was managed in a collaborative setting by specialists from physical medicine and rehabilitation (PMR), physical therapy (PT), and neuropsychology (NPsy).CASE DESCRIPTION: The patient was a 37-year-old female middle school teacher and triathlete with insidious 12-month onset of diffuse left up-per extremity, right upper trap, bilateral periscapular, and neck pain. Previous treatment included PT at a different clinic for 2 months prior


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The KOOS was administered at initial evaluation and every 2 weeks that the patients attended PT. The KOOS scores on the individual subsections were compared statistically between the 2 groups using a mixed proce-dure linear model with SAS statistical package. Descriptive statistics were run as well as correlative statistics to determine statistically significant differences between the groups on the KOOS.RESULTS: There were no statistically significant differences between the 2 groups on any of the KOOS scores at baseline, nor any demographics such as age, sex, BMI, etc. All individuals showed a statistically significant im-provement in KOOS scores over time (P<.0001). When the 2 groups were compared using those patients who had completed at least 6 weeks of PT, there was a statistically significant difference seen in the KOOS subscales of symptoms (P = .045) and quality of life (P = .027), and approached a statistically significant difference in the KOOS subscale of pain (P = .077).CONCLUSIONS: Patients who finished 6 weeks of physical therapy with an accelerated rehab protocol reported significantly less pain and symptoms and increased quality of life than those who attended PT less frequently.CLINICAL RELEVANCE: The findings of this research suggests that there may be a benefit to an accelerated rehabilitation protocol with increased fre-quency of outpatient PT visits following TKA surgery.

OPO168USE OF ORTHOPAEDIC MANUAL THERAPY AND THERAPEUTIC EXERCISE FOR TREATMENT OF DIZZINESS WITH CERVICOGENIC HEADACHEAntonio Nogueras, Trent Harrison, Jason BeneciukBrooks Rehabilitation/University of North Florida Orthopaedic Residency Program, Jacksonville, FloridaBACKGROUND AND PURPOSE: Physical therapists need to evaluate and when appropriate, treat the vestibular system and cervical spine to reduce diz-ziness associated with headaches. The purpose of this case report is to demonstrate the need to evaluate, and when appropriate, treat the cer-vical and thoracic spine to reduce dizziness associated with headaches.CASE DESCRIPTION: The patient was a 27-year-old woman who was re-ferred to outpatient physical therapy with a diagnosis of vertigo. At ini-tial examination, primary symptoms consisted of dizziness, imbalance, headaches that originated to the left side of the occiput, and cervical pain. Initial examination findings were negative for peripheral vestibu-lar dysfunctions. Positive examination findings included limited cervical range of motion, decreased passive joint mobility of the subcranial and thoracic spine, and decreased strength of the scapulothoracic muscula-ture. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, the Dizziness Handicap Inventory, and the Patient Specific Functional Scale. Treatment consisted of manual therapy tech-niques to the cervical and thoracic spine, therapeutic exercises to the up-per quarter, and patient education over an 8-week episode of care.OUTCOMES: Interventions decreased cervical spine pain and head-ache intensity. Complaints of dizziness decreased as headache intensi-ty decreased. At discharge, the patient reported 0/10 cervical pain, Neck Disability Index score improved from 40% to 18%, Dizziness Handicap Inventory score improved from 46 to 19, patient specific functional scale average scores improved from 4.3 to 9.0.DISCUSSION: This case report identifies an undiagnosed cervical dysfunc-tion, cervicogenic headache, in association with dizziness. In similar cas-es, clinicians may only attempt to treat the dizziness because it was the di-agnosis listed on the referral from the physician. Physical therapists need to combine a thorough subjective and objective assessment to determine the cause of cervical pain, headache, and dizziness. Specific questioning and assessment of positions that contribute to the onset, duration, and fa-tigability of symptoms can aide in differential diagnosis.REFERENCES: 1. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clin-ical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1-A34 2. Cleland JA, Glynn P, Whitman JM, Eberhart SL,

zation CPR criteria were met, change score in Oswestry Disability Index (ODI) and Numeric pain rating (NPR), chronicity of symptoms (days since initial onset), number of visits, and previous episodes of LBP. In or-der to identify if any individual component of the CPR was more predic-tive of success, a hierarchical regression was performed with ODI change as the dependent variable and the 4 components of the CPR as the inde-pendent variables in the second step of the model, after controlling for chronicity of symptoms.RESULTS: Of the 462 patients classified as stabilization, 45 met 0/4 criteria (9.7%), 160 met 1 criterion (34.6%), 150 met 2 criteria (32.5%), 84 met 3 criteria (18.2%), and 23 met all 4 criteria (5.0%). There were no signif-icant associations between the number of criteria met and ODI change (F4,457 = 0.542, P = .705), pain change (F4,455 = 0.425, P =.790), or number of visits (F4,457 = 0.655, P =.623). In the hierarchical regression, each step of the model was significant. After step 1, with chronicity in the equation) (R2 = 0.035, F1,460 = 16.70, P<.001). After step 2, with all 4 of the criteria in the model (R2 = 0.016, F5,456 = 4.90, P<.001). A positive prone instabil-ity test had a significant impact on ODI change (R2 = 1.58, P = .033) in acute and subacute patients.CONCLUSIONS: In this retrospective review the total number of CPR crite-ria met did not have a statistically or clinically significant impact on ODI change score in patients who were treated with lumbar stabilization ex-ercises. Having a positive PIT test in a patient seen less than 6 months from onset of LBP did have a statistically significant impact on outcomes.CLINICAL RELEVANCE: This retrospective review did not show any greater improvement in ODI change scores for patients who were treated with primary intervention of stabilization exercises and who met the stabili-zation CPR versus those who did not. This calls into question the clinical usefulness of the stabilization CPR and its utility as a subgroup within the TBC to direct clinicians towards most effective care. This conclusion is in alignment with other clinical commentaries recently published. More re-search is necessary to determine the need for the stabilization subgroup within the TBC.

OPO167THE IMPACT OF AN ACCELERATED REHABILITATION PROTOCOL IN PATIENTS FOLLOWING MINIMALLY INVASIVE TKA WITH IOVERATimothy K. Nelson, Kenneth Milton, Aaron Rhodes, Chris Wilcox, Jeffrey A. Thompson, Vinod DasaPhysical Therapy, LSUHSC New Orleans, New Orleans, Louisiana; Orthopedics, LSUHealth New Orleans, New Orleans, LouisianaPURPOSE/HYPOTHESIS: Total knee arthroplasty (TKA) is one of the most fre-quently performed surgeries in the US, and the incidence is expected to grow in the next 15 years. This high volume continues to contribute to the escalating cost of health care. Iovera, a process of percutaneously freez-ing sensory nerves prior to surgery has been developed to decrease hos-pitalization and recovery time following TKA. With Iovera, patients have decreased postsurgical pain and are able to tolerate increased frequen-cy of outpatient PT. This study investigated the impact of an accelerat-ed rehab protocol on patient outcomes when compared to a more tradi-tional frequency of outpatient PT visits following TKA surgery with the Iovera procedure.NUMBER OF SUBJECTS: This study was a retrospective chart review of med-ical records of all patients who had a TKA from a single surgeon over a 2-year period. Patients were grouped into a high frequency (accelerated) or low frequency group (traditional) based on the number of PT visits at-tended in the first 3 weeks of outpatient PT. Individuals who attended at least 9 times in the first 3 weeks were considered high frequency and those who attended 8 times or less were grouped into low frequency. A to-tal of 54 patient records were accessed, 25 in the low frequency group and 29 in the high frequency group.MATERIALS/METHODS: The researchers accessed the PT charts for all 54 patients and gleaned data collected by the PTs. The outcome measure used was the Knee injury and Osteoarthritis Outcome Score (KOOS).


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consideration of a neurogenic component to the pain. Slump with a neu-tral pelvis and the addition of cervical flexion to an already sensitized SLR identified positive neurodynamic findings in this case. This nonir-ritable, chronic condition required clinical reasoning to identify positive neural provocation outside the standard SLR and slump testing positions and resulted in positive outcomes with the addition of neuromobiliza-tion interventions.REFERENCES: Mason DL, Dickens V, Vail A. Rehabilitation for hamstring injuries. Cochrane Database Syst Rev. 2007. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: Recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40:67-81. DeWitt J, Vidale T. Recurrent hamstring injury: consideration following operative and nonoperative management. Int J Sports Phys Ther. 2014;9:798-812. Schmitt B, Tim T, McHugh M. Hamstring injury rehabilitation and prevention of reinju-ry using lengthened state eccentric training: a new concept. Int J Sports Phys Ther. 2012;7:333-341. Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal hamstring tendinopathy: clinical aspects of assessment and management. J Orthop Sports Phys Ther. 2016;46:483-493. Martin HD, Kivlan BR, Palmer IJ, Martin RL. Diagnostic accuracy of clinical tests for sciatic nerve entrapment in the gluteal region. Knee Surg Sports Traumatol Arthrosc. 2014;22:882-888. Majlesi J Togay H Ãœnalan H Toprak S. The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation. JCR: J Clin Rheum. 2008;14:87-89.

OPO170THE VALIDITY OF THE SIT-TO-STAND TEST IN CLASSIFYING GLOBAL FOOT MOBILITYJennifer Norwood, Carissa Lane, Mark W. CornwallPhysical Therapy and Athletic Training, Northern Arizona University, Flagstaff, ArizonaPURPOSE/HYPOTHESIS: The Sit-to-Stand (STS) test is a simple way to clas-sify the overall mobility of a patient’s foot. The test involves comparing the change in a person’s nonweightbearing and weightbearing foot pos-ture and then classifying their mobility as “Hypomobile,” “Hypermobile” or “Normal.” Unfortunately, the validity of this simple test has not been investigated. The purpose, therefore, of this study was to determine if the STS test has sufficient validity to be used clinically.NUMBER OF SUBJECTS: Sixty-four.MATERIALS/METHODS: Sixteen male and 48 female subjects with a mean ± SD age of 25 ± 4.1 years participated in the study. Each subject’s dorsal arch height (DAH) and midfoot width (MFW) was first measured at 50% of their overall foot length in nonweightbearing and weightbearing us-ing a digital caliper or linear gauge. The change between the nonweight-bearing and weightbearing measurements was then calculated for each foot. A global foot mobility measure, called the mobility magnitude (MM) was also calculated for each subject using the change in DAH and MFW. Using normative data for these measurements, the subject’s foot mobil-ity was classified as “Hypomobile” (first quartile), “Normal” (second and third quartile), or “Hypermobile” (fourth quartile). Each subject’s foot mobility was then visually assessed and classified by 2 different raters as “Hypomobile” (less than 25% change), “Normal” (25%-75% change), or “Hypermobile” (greater than 75% change) without knowledge of the pri-or linear measurements. Rater 1 was inexperienced while Rater 2 was ex-perienced in the evaluation and management of foot and ankle disorders. A series of Cohen’s kappa coefficients, adjusted for bias and prevalence, were used to assess the amount of agreement between the visual classifi-cations of foot mobility and the objective linear measurements.RESULTS: The kappa coefficients for the 2 raters ranged from 0.051 to 0.133 for DAH, from 0.109 to 0.309 for MFW and from 0.121 to 0.273 for MM. These kappa coefficients would be categorized as between “slight to fair” agreement. The kappa coefficients did not appear to be significantly influ-enced by the level of education or experience of the raters.

Macdonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. 2007:431-440. 3. Domenech MA, Sizer PS, Dedrick GS, McGalliard MK, Brismee JM. The deep neck flexor endurance test: Normative data scores in healthy adults. PM R. 2011;3:105-110. 4. Grimsby O, Rivard J. Science Theory and Clinical Application in Orthopaedic Manual Physical Therapy, Volume 1: Applied Science and Theory. Taylorsville, UT: Academy of Graduate Physical Therapy; 2008. 5. Page P. Cervicogenic headaches: an evidence-led ap-proach to clinical management. Int J Sports Phys Ther. 2011;6:254-266. 6. Reid et al: Efficacy of manual therapy treatments for people with cervi-cogenic dizziness and pain protocol of a randomised controlled trial. BMC Musculiskelet Disord. 2012;13:201. 7. The International Classification of Headache Disorders. 3rd ed (beta version). 2013;629-808. 8. Thiele A, Barraclough A. The framework for physical therapist and physician as-sistant partnership: interprofessional education and collaborative pa-tient-centered care. [serial online]. 2007;21:47-52. 9. Young, IA, Cleland, JA, Michener, LA, Brown, C. Reliability, construct validity, and respon-siveness of the Neck Disability Index, Patient Specific Functional Scale, and Numeric Pain Rating Scale in patients with cervical radiculopathy. 831-839.

OPO169THE SLACK OF THE SLUMP: FALSE-NEGATIVE NEURAL PROVOCATION TESTING WITH A CHRONIC PROXIMAL HAMSTRING TEAR: A CASE REPORTTimothy J. Nolan, Adam M. AndersenUniversity of Illinois at Chicago, Chicago, IllinoisBACKGROUND AND PURPOSE: Proximal hamstring tears are commonly seen in the young, athletic population with an injury involving quick move-ments. While clinical recommendations have been published on the treatment of hamstring injuries, there is little literature on the physical therapy management of individuals with chronic hamstring tears. With a hamstring tear, neural provocation testing including straight leg raise (SLR) and slump is utilized to identify any sensitivity of the peripheral or central nervous system. The slump test is traditionally performed as seat-ed spinal flexion, knee extension, and ankle dorsiflexion with cervical mo-tions creating a change to distal symptoms. The purpose of this case is to describe the differential diagnosis and clinical reasoning process of an in-dividual presenting with persistent buttock pain.CASE DESCRIPTION: A 60-year-old woman presented with a 12-month his-tory of right ischial tuberosity pain. MRI confirmed a tear of the proximal hamstring tendons with 10 mm of retraction. Her buttock pain worsened to 8/10 pain with walking up hills, stair ascent, and sitting. At initial eval-uation, standard slump testing and passive SLR testing with hip IR, ad-duction, and ankle dorsiflexion were negative. The tear was identified as the primary pain generator shown with pain upon palpation and reduced hamstring strength and flexibility. Nonthrust hip joint mobilizations, ec-centric hamstring strengthening, soft tissue mobilization and hamstring stretching were utilized for 7 visits with a home exercise program. Due to minimal change on the Lower Extremity Functional Scale (LEFS), continued pain with aggravating activities, and the anatomical proxim-ity of neural tissue to the hamstring origin, neural provocation testing of passive SLR with a combination of all sensitizing maneuvers including cervical flexion and slump testing with a neutral pelvis was performed resulting in positive findings. Seated, supine, and long sitting neural mo-bilizations using cervical flexion while positioned in hip flexion, IR, ad-duction and a neutral pelvis were utilized for 6 additional sessions.OUTCOMES: From the Visit 1 to Visit 8, her pain reduced from 8/10 to 4/10 at worst. Her global rating of change (GRoC) was +2. A little bit better, and her LEFS went from 51/80 to 53/80. With the addition of neural mo-bilizations, her pain was 1/10 at worst, GRoC was +6 A great deal better, and LEFS was 67/80.DISCUSSION: Lack of improvement with hip mobilizations, stretching, soft tissue mobilization, and eccentric hamstring strengthening led to the re-


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V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A sys-tematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435. 4. Committee on Advancing Pain Research, Care, and Education, Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011. 5. Courtney CA, et al. Joint mobilization enhances mechanisms of conditioned pain modu-lation in individuals with osteoarthritis of the knee. J Orthop Sports Phys Ther. 2016. 6. Abbott JH, et al. The incremental effects of manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther. 2015;45:975-983. 7. Deyle G, Gill N. Well-tolerated strategies for managing knee osteoar-thritis: a manual physical therapist approach to activity, exercise, and advice. Physician Sports Med. 2012;40:12-25. 8. Riddle DL, Wade JB, Jiranek WA, et al. Preoperative pain catastrophizing predicts pain out-come after knee arthroplasty. Clin Orthop Relat Res. 2010;468:798-806. 9. King C, Sibille K, Fillingim R, et al. Experimental pain sensitivity dif-fers as a function of clinical pain severity in symptomatic knee osteo-arthritis. Osteoarthritis Cartilage. 2013;21:1243-1252. 10. Nijs J, Van Houdenhove AB, Oostendorp R. Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiolo-gy in manual therapy practice. Man Ther. 2010;15:135-141. 11. Louw A, et al. Use of an abbreviated neuroscience education approach in the treat-ment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28:50-62. 12. Louw A, Diener I, Butler D, Puentedura E. The effect of neuroscience education on pain, disability, anxiety, and stress in chron-ic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92:2041-2056 13. Nijs J, Meeus M, et al. A modern neuroscience approach to chronic spi-nal pain: combining pain neuroscience education with cognition-tar-geted motor control training. Phys Ther. 2014; 94:730-738. 14. Dowsey MM, Nikpour M, Dieppe P, et al. Associations between preoperative ra-diographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis Cartilage. 2012;20:1095-1102. 15. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91:700-711.

OPO172HAND DOMINANCE AND POSTURE: A STUDY OF HANDEDNESS PATTERNS IN POSTURE ANALYSISElizabeth Oakley, Natalie Appelhans, Alyson Jamel, Meredith Griffin, Lauryl Murphree-JamesPhysical Therapy, Andrews University, Berrien Springs, MichiganPURPOSE/HYPOTHESIS: The purpose of this study was to identify if hand dominance postural patterns, as described by Florence Kendall, can be identified in a standing posture assessment and if sex influences posture. Our hypothesis was that hand dominance and sex would have an effect on posture as demonstrated by measured postural deviations unique for each subset of participants.NUMBER OF SUBJECTS: Thirty-eight participants were recruited for our study, 12 males (32%) and 26 females (68%) with a mean age of 26 years. Thirty-two were right-handed (84%) and 6 were left-handed (16%). Inclusion criteria for our study included healthy male and female partici-pants between the ages of 18 and 65 without any postural abnormalities.MATERIALS/METHODS: Standing posture of each subject was analyzed against a plumb line and posture grid in the lateral and posterior view in addition to photographic assessment. Measurements were taken for the craniocervical angle, shoulder levels, spinal alignment, pelvis and hip levels, knee alignment, and rearfoot pronation. Statistical analysis: fre-quencies were used to determine the presence of postural pattern associ-ated with hand dominance and sex. A mixed-design, repeated-measures ANOVA was used to determine if there was a difference in the frequencies of each postural deviation observed for hand dominance and sex.RESULTS: No one demonstrated all 5 postural deviations descriptive of a

CONCLUSIONS: Both raters demonstrated between slight and fair agree-ment between the subjective visual assessment and the objective linear measurement of foot mobility. As such, it cannot be recommended as a clinical tool to classify overall foot mobility. Further research is warranted to find a better screening tool that can be used to easily and quickly clas-sify overall foot mobility.CLINICAL RELEVANCE: The STS test did not demonstrate sufficient agree-ment with the objective linear measurements of foot mobility to warrant clinical use to classifying a patient’s overall foot mobility. Clinicians should rely on other methods of measuring or classifying global foot mobility.

OPO171USING ABBREVIATED THERAPEUTIC NEUROSCIENCE EDUCATION AS AN ADJUNCT TO EXISTING MANUAL THERAPY AND THERAPEUTIC EXERCISE INTERVENTIONS IN THE TREATMENT OF CHRONIC KNEE PAIN IN A 59-YEAR-OLD MALE PATIENT WITH KNEE OSTEOARTHRITIS: A CASE REPORTMaria Anjanette NunezBenchMark Rehab Partners Orthopedic Residency, Atlanta, GeorgiaBACKGROUND AND PURPOSE: Traditionally, physical therapy treatment of chronic knee pain associated with knee OA has been based on a biomed-ical model, focusing on anatomical pathology. However, patients with chronic knee pain receiving an integrated physical therapy treatment pro-gram may still report pain and difficulty with performance of ADLs, lead-ing to seek further treatment including surgery, steroid injections and re-liance on pain medication. Research on pain neurophysiology has shown that individuals with moderate to severe symptomatic knee OA demon-strate central sensitization due to an altered central processing of pain. Therapeutic neuroscience education (TNE) is an effective intervention for patients with chronic pain conditions. The aim of this case report is to demonstrate how the addition of TNE to an existing physical thera-py regimen of manual therapy, therapeutic activity and therapeutic exer-cise affects pain and function in a patient with chronic knee pain associ-ated with knee OA.CASE DESCRIPTION: The patient was a 59-year-old man presenting to phys-ical therapy with a chief complaint of a 2-year history of chronic right knee pain. At baseline and at a 4-week re-evaluation, pain and function were measured by the numeric pain-rating scale (NPRS) and the Lower Extremity Function Scale (LEFS). Fear-avoidance and pain catastrophiz-ing were assessed using the Fear-Avoidance Belief Questionnaire physical activity (FABQ-PA) and work (FABQ-W) subscales modified to the knee and the Pain Catastrophizing Scale (PCS). Walking tolerance and func-tional active movements of squatting and kneeling were also assessed. Treatment consisted of 5 to 10 minutes of TNE at the beginning of each session, 3 times a week for 4 weeks in addition to an existing treatment plan of therapeutic exercise and manual therapy.OUTCOMES: After 4 weeks of TNE education integrated into therapeutic exercise and manual therapy interventions, the patient’s LEFS increased by 110% (11 points). The patient had decreased fear-avoidance behav-ior (FABQ-PA score change from 24/24 at baseline to 7/24; PCS score change from 44/52 to 20/52). Pain at worst also decreased from 8/10 to 4/10.DISCUSSION: decrease in pain, fear avoidance for physical activity, pain cat-astrophizing, and improvement in functional outcome measure tools for function, and active functional movement over a 4 week span. The addi-tion of TNE did not affect fear avoidance for work subscale. The results of this case report suggest that TNE can easily be integrated into a mul-timodal intervention model for the treatment of chronic knee pain asso-ciated with knee OA.REFERENCES: 1. Nguyen U. et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011;155:725-732. 2. Kittelson AJ, George SZ, et al. Future direc-tions in painful knee osteoarthritis: harnessing complexity in a hetero-geneous population. Phys Ther. 2014;94:422-432. 3. Beswick A, Wylde


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decrease in symptoms and functional limitations after the rehabilitation program for both subgroups).CONCLUSIONS: A 6-week rehabilitation program improves function in pa-tients with RC tendinopathy and restores to normal proprioception abil-ity in those with deficits at baseline.CLINICAL RELEVANCE: Our result supports the idea that RC tendinopathy is multifactorial and that functional limitation is not directly link to pro-prioception ability. A rehabilitation program is effective for patients with RC tendinopathy and improves proprioception if impaired.

OPO174THE EFFECT OF LOWER EXTREMITY STRENGTHENING AND FLEXIBILITY ON PITCHING BIOMECHANICS IN PITCHERS WITH UPPER EXTREMITY INJURIES: A CASE SERIESAlexandra PerryCollege of Public Health and Health Professions, University of Florida, Gainesville, FloridaBACKGROUND AND PURPOSE: Rehabilitation for overhead athletes typically focuses on upper extremity interventions, despite the fact that the pitch-ing motion is a complex sequence of movements requiring the coordina-tion of the lower extremities, pelvis, trunk and the upper extremities to achieve ball velocity. The purpose of this study was to compare the effec-tiveness on pitching performance of traditional upper extremity biased rehabilitation to traditional rehabilitation augmented with lower extrem-ity focused interventions in pitchers with upper extremity injuries due to overhead throwing.CASE DESCRIPTION: Five pitchers (mean ± SD age, 18.6 ± 4.7 years; weight, 181.0 ± 19.6 lb;, height, 73.6 ± 1.9 inches) with upper extremity patholo-gy due to overhead throwing were recruited. Subjects were randomly as-signed to receive standard care (SC group): traditional, upper extremity (UE) focused interventions or SC plus lower extremity (LE) interventions (hybrid group). Both stride LE (lead leg) and stance LE (push-off leg) was assessed. Subjects’ passive hip internal rotation (IR) and external rota-tion (ER) range of motion (ROM), knee flexion angle at lead foot contact, and shoulder ER ROM in late cocking was assessed while pitching with a 2-motion video capture system pre and post physical therapy interven-tion (12.6 ± 5.8 visits).OUTCOMES: There was a significant decrease of the stride LE hip IR ROM for the SC group, compared to the hybrid group, (mean ± SD change, –6.5° ± 3.0°; P = .024). There was a significant increase in hip IR ROM of the stride LE (mean ± SD difference, 6.3° ± 3.3°; P = .014) and hip ER ROM of the stance LE (mean difference, 5.5° ± 3.4°; P = .050) postint-ervention between groups. There were significant changes, with an in-crease in knee flexion (mean ± SD change, +9.4° ± 8.4°; P = .022) and de-crease in shoulder ER (mean ± SD change, –2.0° ± 3.1°; P = .037) seen in the hybrid group.DISCUSSION: Implementation of traditional rehabilitation augmented with LE interventions could potentially assist with reducing stress on the throwing arm. Inhibiting the loss of stride hip IR and increasing knee flexion will decrease shoulder ER angle that will allow the efficient trans-fer of energy up the kinetic chain. Addressing stride length and direc-tion with traditional upper extremity focused rehabilitation augmented by lower extremity intervention may improve the timing of the throwing shoulder during stride foot contact, decreasing the strain on the shoul-der and elbow.REFERENCES: Calabrese G. Pitching mechanics, revisited. Int J Sports Phys Ther. 2013:652-660. Laudner K, Wong R, Onuki T, Lynall R, Meister K. The relationship between clinically measured hip rotational motion and shoulder biomechanics during the pitching motion. J Sci Med Sport. 2014. Ramsey D, Crotin R, White S. Effect of stride length of overarm throw-ing delivery: a linear momentum response. Hum Mov Sci. 2014:185-196. Robb A, Fleisig G, Wilk K, Macrina L, Bolt B, Pajaczkowski J. Passive ranges of motion of the hips and their relationship with pitching biome-chanics and ball velocity in professional baseball pitchers. Am J Sports

handedness pattern. Of the possible 5 postural deviations, 3% (n = 1) of right-handed participants and 33% (n = 2) of left-handed participants demonstrated 3 characteristics associated with their hand dominance pattern, 34% (n = 11) of right-handed and 50% (n = 3) of left-handed participants presented with 2, 38% (n = 12) of right-handed and 0% of left-handed participants presented with only one, and 25% (n = 8) of right-handed participants and 16% (n = 1) of left-handed participants presented with none of the characteristics. There was no consistent pos-ture pattern among the sexes. A repeated-measures ANOVA found that neither hand dominance or sex was statistically significant for any of the postural variables.CONCLUSIONS: This study found that hand dominance and sex do not have an effect on a person’s posture. Thus, we rejected our hypothesis that hand dominance and sex would have an effect on posture as demonstrated by measured postural deviations unique for each subset of participants.CLINICAL RELEVANCE: Participants exhibited multiple variations of Kendall’s proposed handedness posture patterns suggesting that there are other factors of greater influence on posture that should be given more impor-tant consideration than hand dominance and sex. Thus, clinicians should not assume that an observed postural pattern is due to hand dominance or sex.

OPO173GLOBAL REHABILITATION IMPROVES UPPER-LIMB PROPRIOCEPTION IN INDIVIDUALS WITH ROTATOR CUFF TENDINOPATHYBenoit Pairot de Fontenay, Jean-Sebastien Roy, Catherine Mercier, Laurent J. BouyerCIRRIS, Quebec, Quebec, CanadaPURPOSE/HYPOTHESIS: Shoulder disorders affects approximately 20% of the population, and rotator cuff (RC) tendinopathy is the most prevalent shoulder diagnosis [1]. Proprioception deficits have been highlighted in patients with RC tendinopathy during shoulder-specific active reposition-ing tasks as well as during multijoint upper limb repositioning task [2,3]. As proprioception is fundamental for joint control, a deficit could con-tribute to changes in shoulder muscle activations and kinematics, and ul-timately to pain and disabilities [4]. A global rehabilitation intervention has already demonstrated benefits for pain and function in patients with RC tendinopathy [5]. However, it is unknown how it affects propriocep-tion. The aim of this study was to evaluate the effects of a 6-week reha-bilitation program on upper limb proprioception in individuals with RC tendinopathy.NUMBER OF SUBJECTS: Twenty-three individuals with RC tendinopathy.MATERIALS/METHODS: Upper-limb joint position sense was evaluated be-fore and after a 6-week rehabilitation program by an active-repositioning (AR) task in participants with RC tendinopathy. The task was executed in a seated position and the subjects were blindfolded. The movement as-sessed was a multijoint joint reaching movement of the upper limb. The difference between the determined position and the reaching position was measured. The mean error in lateral (LR), neutral (NR), and medial rotation (MR), and the global mean error were reported. Symptoms and functional limitations were assessed using the DASH questionnaire be-fore and after the intervention.RESULTS: Paired t tests showed a significant decrease only for the error in LR (P = .044). As more than 50% of the patients did not present any deficits of proprioception at baseline based on normative data (20 sub-jects without shoulder deficit), we decided to separate the patients into 2 subgroups (patients with and without proprioception deficit at baseline). Subgroup ANOVA showed significant interaction for the global error and the error in LR (P = .045 and P = .017, respectively). Post hoc tests showed a decrease in global error and in error in LR after the intervention in pa-tients with deficit at baseline (P = .022 and P = .002, respectively), and proprioception ability was not different between both subgroups at the end of the intervention (P = .204 and P = .342, respectively). A significant time effect was reported for the DASH questionnaire (P<.001, meaning a


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purpose of this poster is to demonstrate how dorsiflexion mobility impair-ments impact fundamental movement patterns.NUMBER OF SUBJECTS: One hundred forty-six subjects.MATERIALS/METHODS: An observational analytical cohort study was con-ducted. A sample of convenience of 146 collegiate athletes was obtained. The study was approved by the IRB of Lebanon Valley College. Inclusion criteria included: (1) self-reported lack of musculoskeletal injury with-in 6 months prior to data collection, (2) no musculoskeletal pain at time of testing, (3) medically cleared for sport participation by a physician. Informed consent was obtained from each subject. Closed chain dorsi-flexion range of motion was assessed utilizing the lunge test as described by Chisolm. The squat movement pattern was assessed utilizing the Functional Movement Screen criteria. Statistical analysis was performed to explore the correlation between closed chain dorsiflexion limitations and a dysfunctional squat.RESULTS: A cut score for limited dorsiflexion of less than 10 cm was set and a score of “1” on the deep squat test of the Functional Movement Screen were investigated. 67 (46.2%) Subjects scored either a “2” or “3” on their deep squat. Six of these subjects (9%) had both ankles dorsiflex less than 10 cm. 11 subjects (16.4%) had at least 1 ankle dorsiflex less than 10 cm. 78 subjects (53.8%) scored a “1” on their deep Squat test. Of this group, 23 subjects (29.5%) had a bilateral dorsiflexion restriction and 33 sub-jects (42.3%) had a unilateral restriction. Subjects who scored a “1” on their deep squat test were 3.73 times as likely to have at least 1 ankle dor-siflex less than 10 cm compared to subjects who scored a “2” or a “3” on their deep squat test based on an odds ratio analysis (OR = 3.73; 95% con-fidence interval: 1.60, 8.88; P = .002.).CONCLUSIONS: A dysfunctional squat pattern can be correlated with a uni-lateral or bilateral lack of closed chain dorsiflexion mobility. Clinicians who identify a dysfunctional squat utilizing the Functional Movement Screen or assessing a functional task may benefit from looking at closed chain dorsiflexion mobility. Ankle equinus may limit the ability to squat for functional tasks placing excessive stress on more proximal body structures.CLINICAL RELEVANCE: Physical Therapists have an obligation to effectively manage the complex neuromusculoskeletal system with the goal of re-ducing the activity limitations in our patients. Considering regional in-terdependence implications, movement dysfunction can be a product of clinically meaningful impairments within the kinetic chain. To this end, a key component to our management model should center on fundamen-tal movement restoration.

OPO177THE EFFECT OF VARIOUS SITTING POSTURES ON SHOULDER LATERAL ROTATOR STRENGTHSteven Pheasant, Richard Haydt, Thomas Gottstein, Anthony J. Grasso, Nicholas M. Lombard, Brandon L. StonePhysical Therapy, Misericordia University, Dallas, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose was to assess the relationship between 3 sitting postures and shoulder lateral rotator strength. The null hypothe-sis was that maintaining various sitting postures for 5 minutes would have no effect on force production using the lateral rotators of the shoulder.NUMBER OF SUBJECTS: One hundred healthy volunteers (39 male, 61 fe-male) ages 20 to 26 years.MATERIALS/METHODS: Each subject was placed in a neutral (NCS) cervi-cal sitting posture which was maintained for 5 minutes after which the strength of the dominant shoulder lateral rotators was immediately tested using a microFET3 HandHeld Muscle Testing Dynamometer (HHMTD). Strength testing consisted of (3) 5-second “make tests” for shoulder lat-eral rotation. Subjects were instructed to provide a maximal effort for 5 seconds while the tester maintained the static position of the HHMTD. A 10-second rest period separated each of the 3 trials. The position for strength testing was 0° of glenohumeral abduction, 0° of glenohumeral external rotation and 90° of elbow flexion. The HHMTD was held on the

Med. 2010:1-7. Seroyer S, Nho S, Bach B, Bush-Joseph C, Nicholson G, Romeo A. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health. 2010:135-146.

OPO175SURGICAL INDICATIONS FOR FEMOROACETABULAR IMPINGEMENT WITH/WITHOUT ACETABULAR LABRAL TEAR: A SCOPING REVIEWScott Peters, Alisha Laing, Courtney Emerson, Kelsey Mutchler, Thomas Joyce, Michael ReimanDuke University Physical Therapy, Durham, North CarolinaPURPOSE/HYPOTHESIS: The prevalence of cam femoroacetabular impinge-ment (FAI) is estimated to range from 5% to 75%, while pincer FAI prev-alence is more consistently reported at 61% to 76% of patients presenting with hip and/or groin pain. The consistency of specific criteria reporting for diagnosis and surgical treatment of FAI appears unclear, despite re-cent suggestions for comprehensive and concise inclusion/exclusion cri-teria for FAI surgery. Therefore, the purpose of this review was to ana-lyze and report the indications utilized for open and arthroscopic surgical treatment of FAI. We hypothesized that radiographic evidence of FAI would be the primary indication for surgery.NUMBER OF SUBJECTS: Within the scoping review there were 10 078 patients (56.2% male; mean age, 33 years) and 10 698 hips included from 110 ar-ticles matching the inclusion criteria.MATERIALS/METHODS: A librarian assisted computer search of MEDLINE, CINAHL, and Embase for articles related to surgical indications for FAI was employed for study inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were also used for the search and reporting phases of this study. Inclusion criteria for this review included: studies of subjects with surgical treatment of FAI, studies with the primary purpose of surgery or surgical outcomes for treatment of FAI, and studies with defined indications for FAI surgery.RESULTS: Radiographic imaging (eg alpha angle, central edge, crossover sign) was a surgical indication in 78% of the included studies. Subjective history was a reported surgical indication in 74% of the studies, and spe-cial tests were reported in 69% of studies. Various range-of-motion limi-tations were described in only 28%, while 44% of included studies listed previous treatment (eg, NSAIDs, activity modification, PT) as indications for FAI surgery. Failed nonsurgical physical therapy treatment was only reported in 18% of studies as a surgical indication.CONCLUSIONS: As hypothesized, radiographic evidence of FAI was the most commonly reported indication for FAI surgery. Unfortunately, specific in-dications, as well as their specific parameters and values, demonstrated major inconsistencies across the studies.CLINICAL RELEVANCE: The rate of surgical intervention for FAI is continuing to escalate despite poorly described and inconsistently reported surgical indications. The primary surgical indication for FAI surgery is currently radiographic imaging, despite a lack of consensus on the specific modali-ties and cut-off values necessary for this intervention. It remains unclear which indications determine best surgical outcomes for FAI.

OPO176DORSIFLEXION MOBILITY IMPAIRMENTS AND THE REGIONAL INTERDEPENDENCE IMPLICATIONS ON FUNDAMENTAL MOVEMENT PATTERNSSteven J. Pettineo, Michael E. LehrBiomechanics, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania; Physical Therapy, Lebanon Valley College, Lebanon, PennsylvaniaPURPOSE/HYPOTHESIS: The APTA recently issued a vision statement, grounded by the principle of optimizing movement. Physical therapists typically assess isolated movements at the joint level, as well as open and closed kinetic chain functional patterns. Correlation between the 2 are often implied, but research is limited in terms of demonstrating a cor-relation between specific impairments and movement dysfunction. The


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18.4% with 24.2 ± 13 visits across all patients. There were significant in-teraction effects of for visits (P = .04) and LOS (P = .02). Post hoc anal-ysis showed that patients with a tenodesis were seen 2.4 visits fewer if they were greater than 3 cm compared to RCR less than 3 cm and teno-desis during 0 to 6 weeks. Overall, patients with RCR less than 3 cm and tenotomy (4.6 ± 6.8) were seen less than those with tenodesis (7.8 ± 7.7). When considering LOS, patients with tenotomy had shorter LOS (LOS, 94.6 ± 117.6) compared to patients with tenodesis (LOS, 129.6 ± 70.0) fur-thermore, patients with tenotomy and RCR less than 3 cm had shorter LOS (LOS, 66.2 ± 161.1) compared to all other groups. Patients with RCR greater than 3 cm had longer LOS (123.0 ± 71.4) compared to patients with RCR less than 3 cm (93.9 ± 127.1).CONCLUSIONS: The results of this study indicate that tear size and biceps procedure influence PT utilization. In this sample, patients with a biceps tenotomy tended to have less utilization overall as measured by LOS and PT visits. Tear size was likely influenced by early post operative restric-tions based on tear size.CLINICAL RELEVANCE: Clinicians should consider tear size and concurrent biceps procedure when developing postoperative expectations following RCR repair. Understanding the factors that influence will help guide de-velopment of improvement PT utilization in emerging value-based pay-ment models.

OPO179NORMATIVE VALUES FOR THE Y BALANCE TEST IN HEALTHY, ACTIVE YOUNG ADULTSMattie Pontiff, Jane M. Eason, Thuha HoangPhysical Therapy, LSU Health Science Center, New Orleans, LouisianaPURPOSE/HYPOTHESIS: Single-limb balance and dynamic neuromuscular control are important for daily and sport-related activities. The Y Balance test is a valid and reliable measure for assessing single limb balance and neuromuscular control. Scores on the Y Balance test have been related to lower extremity musculoskeletal impairments and predictive of lower ex-tremity injury in select populations. Despite its widespread clinical utility, appropriate reference values have yet to be established for healthy, active, young adults. Normative values based on age, sex, and activity would al-low clinicians to correctly interpret test results to determine patient per-formance and to establish values to be used for screening a young adult population. The purpose of this study was to establish normative values for the Y Balance test in healthy, active, young adults (age range, 20-29 years). Secondary aims included assessment of sex differences in normal-ized reach direction and composite scores.NUMBER OF SUBJECTS: Seventy-four.MATERIALS/METHODS: Healthy young adults between the ages of 20 and 29 years who exercised 1 to 2 d/wk were recruited to participate in this study. Successful reach distances were recorded for each direction and the aver-age for each direction was utilized in calculations. Distances for each di-rection were normalized to limb length. Composite scores were also calcu-lated for each LE. Sex differences were assessed between groups for each reach direction and composite scores using an independent t test (P≤.05). Reference values were calculated for posterior-medial, posterior-lateral, anterior and composite scores for each lower extremity (mean ± SD, 95% confidence interval).RESULTS: Seventy-four subjects (43 female, 31 male) met inclusion criteria and completed the Y Balance test. There were no statistically significant differences between males and females in right and left anterior reach (P = .077, P = .419), right and left posterior medial reach (P = .702, P = .179), right and left posterior lateral reach (P = .175, P = .404) and right and left composite reach (P = .615, P = .756). Mean reach distances for each direc-tion were as follows: right and left anterior (67.72 ± 9.13, 67.21 ± 10.23), right and left posterior medial (107.86 ± 15.21, 110.12 ± 13.77) and right and left posterior lateral (102.49 ± 15.96, 103.26 ± 15.45). Mean reach dis-tances for composite scores were (96.78 ± 11.58 cm) for RLE, and (97.34

dorsum of the distal forearm 2 cm proximal to subjects’ radial styloid pro-cess. Each subject was returned to the NCS posture for subsequent lateral rotator strength testing after 5 minutes in a protruded (PCS) cervical sit-ting posture, 5 additional minutes in the NCS posture and 5 minutes in a retracted (RCS) cervical sitting posture. Subjects were randomized for or-der between the PCS and RCS postures.RESULTS: Mean strength values for each condition were normalized for each subject to the initial NCS posture mean strength values. ANOVA demonstrated significance for shoulder lateral rotator strength decline following the PCS posture (0.92 ± 0.11) compared to each of the strength values following first NCS (1.0), RCS (0.99 ± 0.09) and second NCS (0.97 ± 0.09) postures (P<.05). A frequency analysis revealed 36% of the sub-jects demonstrated greater than 10% decline in lateral rotator strength following 5 minutes in the PCS posture. The average percentage strength deficit of those with greater than 10% decline was 19%.CONCLUSIONS: The PCS posture can have a direct effect on shoulder later-al rotator strength. Shoulder lateral rotator strength declined 8% follow-ing 5 minutes in the PCS posture. A subpopulation of 36% demonstrated an average decline of 19% in shoulder lateral rotator strength following 5 minutes in the PCS posture. The strength decline appears to resolve over the short term by returning to the NCS posture.CLINICAL RELEVANCE: Five minutes in the PCS posture can have a signifi-cant, adverse impact on shoulder lateral rotator force production. The strength decline returns to near normal after 5 minutes in the NCS pos-ture; however, the cumulative effects are unknown. This strength phe-nomenon can likely effect predisposition to injury, occupational tolerance, athletic performance and rehabilitation outcomes.

OPO178INFLUENCE OF TEAR SIZE AND BICEPS PROCEDURE ON PHYSICAL THERAPY UTILIZATION FOLLOWING ROTATOR CUFF REPAIRAbigail R. Pinkerton, Sarah P. Pate, Ellen Shanley, Paul F. Beattie, Michael Kissenberth, Richard J. Hawkins, Charles A. ThigpenResearch and Analytics, ATI Physical Therapy, Greenville, South Carolina; Physical Therapy, University of South Carolina, Columbia, South Carolina; Steadman Hawkins Clinics of the Carolinas, Greenville Health System, Greenville, South CarolinaPURPOSE/HYPOTHESIS: There are between 250 000 and 400 000 rotator cuff repairs (RCR) per year in the United States. Evidence suggests that associated long head of the biceps (LHB) tendon pathology should be ad-dressed in these patients often impacting the physical therapy (PT) plan after RCR. While standard practice following RCR involves regular, su-pervised PT visits, there is no clinical evidence describing dosage of PT following RCR as it relates to tear size and concomitant biceps proce-dure. Therefore, the purpose of this study was to examine the effects of RCR tear size and concomitant biceps procedure on PT utilization fol-lowing RCR.NUMBER OF SUBJECTS: Patients with RCR (n = 114; tenodesis, 51; tenotomy, 63) by 1 of 3 board certified, fellowship trained surgeons who received therapy at 1 physical therapy (PT) clinic following a previously published rotator cuff protocol.MATERIALS/METHODS: Patients were included if they had an index RCR with available pre surgical MRI, operative report, and pre- and 2-year postop-erative ASES scores. Baseline factors including age, sex, BMI, comorbidi-ties, work type, activity level, pain were recorded. PT utilization was de-fined as the total length of stay (LOS) in therapy (from initial evaluation until time of discharge) and number of visits at 6 weeks, 12 weeks, and 3 to 6 months. Tear size was categorized as less than 3 cm (n = 50) or great-er than 3 cm (n = 64). A 2-way ANOVA (tear size by biceps procedure) was used to compare the LOS and dosage of visits over the course of care and a mixed model ANOVA (tear size by biceps group) over phase of re-habilitation on visits (α = .05).RESULTS: ASES scores (pre, 36.5 ± 11.6) increased on average 45.1% ±


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pensation with the hip extensors.

OPO181SIT-TO-STAND WORKSTATIONS AND HOW THEY INFLUENCE PHYSICAL AND PSYCHOLOGICAL WELL-BEING OF SEATED WORKERS: A SYSTEMATIC REVIEW OF RCTSAhmed Radwan, Savannah Bernardin, Nicholas Ball, Spencer Simmons, Julia C. PrimpsUtica College, New Hartford, New YorkPURPOSE/HYPOTHESIS: Increases in sitting behavior within the workplace have led to multiple negative health conditions. Installation of sit to stand workstations can allow users to alternate between the sitting and the standing position. Currently, there is limited evidence on the benefit of such workstations. The aim of this systematic review was to determine the benefits of sit to stand workstations, both physically and psychologically, on seated workers. This review provides useful knowledge to health care professionals regarding ergonomics, health and wellness of employees.NUMBER OF SUBJECTS: Systematic review of 5 randomized controlled trials.MATERIALS/METHODS: Randomized control trials that studied the effects of sit to stand workstations were searched and screened based on the fol-lowing inclusion criteria; being peer-reviewed articles published between January 1, 2011 till January 1, 2016, published in English language, and having participants with an age range of 18 to 65 years. Articles were searched over multiple databases by 2 independent reviewers, followed by assessment of the methodological quality using the PEDro and The Cochrane Collaboration’s tool for assessing risk of bias.RESULTS: The literature search identified 275 potential articles, of these, 5 were included containing a total of 182 participants. The articles had an average PEDro score of 6/10. Three articles were categorized as hav-ing an unclear risk of bias, while the remaining 2 articles were having high risk of bias.CONCLUSIONS: Alternating between sitting and standing during an average workday with the use of a sit-to-stand workstation reduces musculoskel-etal discomfort while maintaining or improving productivity standards.CLINICAL RELEVANCE: Employers are encouraged to consider sit-to-stand work-stations because of their affordability and potential benefits to employees.

OPO182STRENGTH AND RANGE-OF-MOTION DEFICITS RELATED TO FUNCTIONAL MOBILITY POST–MINIMALLY INVASIVE TOTAL HIP ARTHROPLASTYKelsi Rempe, Laura Covill, Vassilios VardaxisPhysical Therapy, Des Moines University, Des Moines, IowaPURPOSE/HYPOTHESIS: Total hip arthroplasty (THA) is an effective surgi-cal technique for individuals in end stage osteoarthritis (OA) for relief of pain and improvement in functional mobility. Gait speed has been re-ported to predict independence in mobility, hospitalizations and fall-risk in older adults [1]. In individuals with OA walking speed is reduced pre surgery and continues to be limited 1 year post-THA [2]. Hasio [3] has demonstrated a strong relationship between walking speed and peak an-terior ground reaction force (aGRF). The primary contributors of peak aGRF in increasing gait speed are trailing limb angle (TLA) and ankle plantarflexion moment (Ma) [4]. TLA represents the line between the center of pressure to the greater trochanter within the sagittal plane [3]. Additional gait abnormalities post THA include limited hip range of mo-tion (ROM) and strength [5]. The purpose of this study was to assess how ROM and strength deficits are related to TLA after THA between 2 min-imally invasive surgeries (MIS), the posterolateral (PL) and direct ante-rior (DA).NUMBER OF SUBJECTS: Forty end stage hip OA patients were recruited to participate in the study. All patients received MIS THA; 20 patients re-ceived PL and 20 the DA approach.MATERIALS/METHODS: Participants were tested at a self-selected walking speed in the gait lab at presurgery, 3, and 12 months post-THA. Kinetic and kinematic data were collected using Cortex 1.1.4. Gait parameters of

± 11.398 cm) for the LLE.CONCLUSIONS: Normative values for the Y Balance test were established for healthy, active adults aged 20 to 29 years. No difference exists between males and females in any reach direction (anterior, posterior medial and posterior lateral) or composite scores when data were normalized for limb length.CLINICAL RELEVANCE: Normative data for The Y Balance test can be used for screening and treatment purposes by physical therapists in clinical prac-tice. Additionally, sex-specific norms are not necessary for the Y Balance test in healthy adults aged 20 to 29 years.

OPO180DETERMINING THE ROLE OF LUMBAR EXTENSOR MOMENT DURING TIME TO TASK FAILURERachael Puthoff, Ryan Kaya, Megan E. Applegate, Samuel T. Leitkam, James S. Thomas, David W. RussRehabilitation and Comunication Sciences, Ohio University, Athens, OhioPURPOSE/HYPOTHESIS: Time to task failure (TTF) on the Sörensen test, which requires individuals to maintain the unsupported trunk in a hor-izontal position, predicts first-time episodes of low back pain (LBP) as well as the development of chronic LBP (cLBP). However, TTF on the Sörensen test may be influenced by trunk mass, trunk length, and strength of the trunk extensor muscles. Thus, we examined TTF in both healthy controls (HC) and subjects with cLBP performing (1) a standard Sörensen test, and (2) a modified test that accounted for anthropometrics and trunk extensor strength.NUMBER OF SUBJECTS: Fifteen subjects (8 cLBP, 7 HC) aged 18 to 45 years.MATERIALS/METHODS: Sessions were separated by at least 72 hours. Subjects were positioned prone with iliac crests aligned with the edge of the table, pelvis secured to the table, and ankles secured using a T-bar with an em-bedded 1-DOF load cell. The trunk rested on a platform connected to a counterbalancing weight stack through a pulley system. A 6-DOF load cell fixed between the floor and the platform was used to assess trunk forces and moments. The eSTIM amplitude of peak twitch force was de-termined. Subjects performed 4 maximal voluntary contractions (MVC) of the trunk extensors during the first session; visual feedback of the ex-tensor moment was provided to encourage maximal effort. For the stan-dard Sörensen test session, only the weight of the platform was counter-balanced. For the modified test session, the counterweight load was set to 30% of the subjects’ maximal trunk extensor moment to maintain the horizontal position. During both sessions, the subjects viewed digitally displayed feedback on trunk position from a potentiometer mounted on the platform. Task failure occurred when the subjects could not maintain the horizontal position (±1°) for greater than 3 seconds. Following each of the tests, an MVC was performed and a 200-microsecond wide doublet pulse was delivered at the subjects’ peak twitch amplitude. The data were analyzed with a mixed model ANOVA.RESULTS: TTF was 139 (SE, 13.9) seconds for the HC group and 93 (SE, 13.0) seconds for the cLBP group (P<.05). Collapsed across groups, TTF was 166 (SE, 16.9) seconds in the modified test compared to 66 (SE, 6.6) seconds in the standard Sörensen test (P<.05). Baseline vertical forces at the trunk (441 N for HC versus 460 N for cLBP) and hip (491 N for HC versus 437 N for cLBP) did not differ between groups. However, base-line trunk extensor moments were significantly lower in subjects with cLBP than in HC (20.5 Nm; SE, 5.8 versus 40.7; SE, 6.3 Nm, respective-ly; P<.05). Peak extensor moment during the posttest MVC doublet was higher in HC compared to cLBP (12.4; SE, 1.5 versus 7.9; SE, 1.4 Nm, re-spectively; P = .051).CONCLUSIONS: Differences in performance on the Sörensen test could be ac-counted for by an inability to generate and sustain trunk extensor moment.CLINICAL RELEVANCE: These findings suggest that individuals with cLBP have specific deficits in motor control that impair generation of lumbar extensor torque that may be missed in classic strength measures by com-


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II PSFS for computer work was rated 6/10, reaching overhead 8/10. At discharge NPRS improved to 0 to 3/10. PSFS was 8/10 for working on computer, 10/10 for reaching overhead.DISCUSSION: For individuals with persistent pain, it is important to consid-er relevant pain mechanisms in terms of peripheral nociceptive input and central processing mechanisms. When treating this patient with a strictly physical impairment based, or bottom up approach, there was no signifi-cant improvement in pain or function. Over the course of treatment with a change from a bottom up to a top down approach, significant improve-ment was seen in pain and function. The transition to consider both the biopsychosocial and central mechanisms as contributors to pain proved to be beneficial in treatment.REFERENCES: Bowering KJ, O’Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, Stanton TR. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-anal-ysis. J Pain. 2013;14:3-13. Johannes C. Le K. Xiaolei Z. Johnston J. Dworkin R. The prevalence of chronic pain in United States adults: re-sults of an internet-based survey. J Pain. 2010;11:1230-1239. Louw A. Diener I. Butler D. Puentedura E. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rahabil. 2011;92:2041-2056. Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology. 200626;67:2129-2134. Nielsen L. Henriksson K. Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition. Best Pract Res Clin Rheumatol. 2007;21:465-480. Prignac V. Stralka S. Graded motor imagery. J Hand Ther. 2011;24:164-168. Smart KM, Blake C, Staines A, Doody C. Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Man Ther. 2010;15:80-87. Walz A. Usichenko T. Moseley L. Lotz M. Graded motor imagery and the impact on pain processing in a case of CRPS. Clin J Pain. 2013;29:276-279.

OPO184A RETROSPECTIVE ANALYSIS OF THE PRESEASON SCREEN USED IN A PROFESSIONAL BALLET COMPANY, WITH RECOMMENDATIONS FOR IMPROVEMENTS IN THE SCREENThomas K. Robinson, Ashley Gowen, Amy Krichau, Ciara Garcia, Ashley HenleySchool of Physical Therapy, Belmont University, Nashville, TennesseePURPOSE/HYPOTHESIS: The objectives were to determine if the current pre-season screen used by the Nashville Ballet was identifying dancers at risk for injury, to determine the injury rates and patterns of injury within the company and to propose measurement tools to enhance the preseason screen.NUMBER OF SUBJECTS: Past screen history from the 2007-2014 seasons was obtained from 285 medical records. Additionally, 17 professional danc-ers from the Nashville Ballet (11 female, 6 male) were assessed prior to the 2015 season.MATERIALS/METHODS: Past screen history from the 2007-2014 seasons was obtained from 285 medical records. The ability of the established preseason screen to predict injury among the injured dancers was de-termined by noting side-to-side differences specifically in the manu-al muscle test and functional movement analysis portions of the screen. Additionally, 17 Nashville Ballet dancers from the 2015 season (11 female, 6 male) were included in the study. Strength was assessed by hand dyna-mometry on the gluteus maximus and gluteus medius muscles of each subject. Three-dimensional motion analysis of the dancers performing demi-plies on the right and left sides in parallel and in turnout were as-sessed. Paired-samples t tests were run with a Bonferroni correction and significance was set at P≤.05.RESULTS: All injuries reported during the 2007-2014 seasons were in the lower extremity. Previous preseason screen data showed the manual mus-

walking speed, TLA, peak aGRF, Ma, and ankle moment arm were pro-duced in Visual3D Version 5. ROM with standard goniometer and man-ual muscle testing of bilateral lower extremities was performed by an ex-perienced physical therapist. Pearson coefficient of correlation were done between TLA and hip extension ROM, hip abduction ROM, hip exten-sion strength and hip abduction strength at Pre, 3, and 12 months on the surgical leg with pooled, PL, and DA group data, in SPSS 22 (IBM), al-pha at .05.RESULTS: No significant correlation existed between TLA and hip exten-sion and abduction ROM. TLA and hip extension strength showed corre-lation at pre (r = 0.60, P = .01) and 3 months (r = 0.36, P = .05) in pooled data but only in pre between the PL (0.54, P = .05) and DA (0.63,P = .01) group. In pooled data, hip abduction strength showed correlation at all measurement time frames (pre: r = 0.40, P = .05; 3: r = 0.44, P = .01; 12: r = 0.46, P = .01). The PL group had correlation in hip abductions strength only at pre surgery (r = 0.41, P = .05) while the DA group at 3 (r = 0.50, P = .05) and 12 months (r = 0.55, P = .05).CONCLUSIONS: Hip extension strength appears to affect TLA before sur-gery and in early rehabilitation but its effect is nonsignificant as healing continues. Hip abduction strength, usually considered controlling pelvic alignment in the frontal plane, also has an effect on movement in the sagittal plane by contributing to TLA throughout the healing continuum.CLINICAL RELEVANCE: Focusing on hip extension and hip abduction strength in early rehabilitation may improve gait speed and improve functional mobility in individuals post-THA.

OPO183CLINICAL MANAGEMENT OF CHRONIC UPPER QUADRANT PAIN: “TOP DOWN” VERSUS “BOTTOM UP” APPROACH: CASE STUDYColleen Robinson, Michael CostelloOutpatient Physical Therapy, Cayuga Medical Center, Ithaca, New YorkBACKGROUND AND PURPOSE: A strict biomedical model is giving way to a deeper understanding of pain mechanisms including central sensitiza-tion and its management. This paradigm shift advocates clinicians ad-dress neuroplastic changes that may contribute to the condition via a “top down approach” in addition to focusing on biomedical pathology alone, “bottom up approach” (Priganc et al 2011). The purpose of this case report is to describe how a top down approach was incorporated in the manage-ment of chronic neck and shoulder pain.CASE DESCRIPTION: A 43-year-old man with 5-year history of neck and shoulder pain, self-referred to physical therapy after being medically cleared via lab tests and imaging. Physical therapy initially took a bottom up approach, focusing on biomechanical impairments of ROM, strength and pain via manual therapy, neurodynamics, and therapeutic exercise. Since no significant functional or objective progression was seen after 4 weeks, the therapist hypothesized that impaired central processing of sen-sory information was relevant. The treatment focus was transitioned to a top down approach. During phase II the therapist utilized a Graded Motor Imagery program and Neuroscience Education for 8 weeks, result-ing in meaningful improvements. In phase III, manual therapy and ther-apeutic exercise were reintroduced to address remaining physical impair-ments in a combined treatment approach. Patient was seen for 18 visits over 4 months.OUTCOMES: Initially the Patient-Specific Functional Scale (PSFS) was rat-ed as follows: working on a computer, 5/10 and reaching overhead, 0/10. The numeric pain-rating scale (NPRS) was constant 5/10. Range of mo-tion (ROM) for shoulder abduction and flexion was 90° each. Following phase I, PSFS remained unchanged, NPRS was 3/10 and constant. Beginning with phase II, laterality recognition was tested with Recognise Online. Accuracy for the left was 60%; response time was 3.5 seconds. In phase II objective and functional measures began to improve. Laterality accuracy improved to 67%; response time was 3.1 seconds, at discharge 90% accurate, 2.7-second response time. Abduction ROM progressed from 105° in phase I, to 156° in phase II and 180° at discharge. In phase


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CLINICAL RELEVANCE: Our 3-D measurement results demonstrate that MPD may not be a significant etiological factor of hallux valgus.

OPO186COMPARISON OF 2 INTERVENTIONS FOR POSTERIOR CAPSULE TIGHTNESS AND SHOULDER PAIN: A RANDOMIZED CONTROLLED TRIALDayana Rosa, John Borstad, Julia K. Ferreira, Vander Gava, Paula CamargoPhysical Therapy, The Ohio State University, Columbus, Ohio; Physical Therapy, Federal University of São Carlos, São Carlos, BrazilPURPOSE/HYPOTHESIS: Glenohumeral joint posterior capsule tightness (PCT) is related to altered internal (IR) and external (ER) rotation of the shoulder, decreased external rotation strength in overhead athletes [1,2], and shoulder pain [3-6]. Considering that PCT and shoulder pain can re-sult in significant functional limitations, studies evaluating the effective-ness of targeted treatment for PCT are needed. This study compared the effects of 2 interventions on PCT, IR and ER ROM, ER strength, pressure pain threshold (PPT), and subjective outcomes in individuals with shoul-der pain and PCT.NUMBER OF SUBJECTS: Fifty-two individuals with PCT and shoulder pain.MATERIALS/METHODS: Subjects were randomized to 2 groups: experimen-tal (mean ± SD age, 41.2 ± 12.8 years; weight, 78.8 ± 13.4 kg; height, 1.72 ± 0.09 m; 41.4 ± 55.3 months of pain) and sham (age, 40.1 ± 12.1 years; weight, 76.1 ± 15.8 kg; height, 1.69 ± 0.08 m; 42.4 ± 35.9 months of pain). Self-reported shoulder pain was confirmed with a clinical examination [7,8]. PCT was determined by a difference between shoulders of at least 7° in the low flexion (LF) test [9]. IR and ER ROM was measured with a digital inclinometer at 90° of shoulder abduction with 90° elbow flex-ion. ER strength was measured with a handheld dynamometer. A blind-ed evaluator took each measurement twice. PPTs for the upper trapezius, infraspinatus, supraspinatus, deltoid, levator scapulae and tibialis ante-rior were assessed 3 times each with a digital algometer. Subjective out-comes were recorded using the SPADI. All variables were evaluated at pre- and posttreatment. The experimental protocol included GHJ pos-terior glide mobilization (5 minutes), sleeper stretching (3 × 30 seconds) and ER strengthening (3 × 10 repetitions). The sham group protocol in-cluded placebo ultrasound (5 minutes), upper trapezius stretching (3 × 30 seconds) and scapular retraction (3 × 10 repetitions). Both protocols were performed 3 times per week for 4 weeks. A mixed-model ANOVA com-pared groups over time with significance set at P<.05.RESULTS: There was a significant interaction (P = .002) for PCT. The ex-perimental group had increased LF test posttreatment (22.8° ± 1.6°) com-pared to the sham group (17.5° ± 1.6°). There was a significant main effect of time for IR ROM, with increased IR ROM (4.56° ± 1.4°) at posttreat-ment. No significant effects were found for ER ROM or ER strength. PPTs increased significantly for upper trapezius, supraspinatus and del-toid at posttreatment for both groups. Both groups had significantly de-creased pain and improved function posttreatment.CONCLUSIONS: The experimental protocol was effective at improving PCT, while both protocols were effective in reducing pain and improving func-tion, IR ROM and local pain sensitivity in individuals with shoulder pain and PCT.CLINICAL RELEVANCE: Matching a treatment (GHJ mobilization) to a spe-cific impairment (PCT) was more effective at improving motion than a nonspecific sham treatment, but not more effective for altering other outcomes. Possible reasons for this finding includes (1) natural recovery, (2) placebo effect from therapist interaction, (3) a real effect of shoul-der movement in the sham protocol, and (4) the chronicity of symptoms.

OPO187THE INTERNAL CONSISTENCY OF A MODIFIED VERSION OF THE LOWER EXTREMITY FUNCTIONAL SCALE FOR PATIENTS RECEIVING A TOTAL JOINT ARTHROPLASTYJames R. Roush, Thomas J. Curtis, Curt Bay, Randall J. Case,

cle testing identified side-to-side gluteus medius differences in 26.92% (n = 26). Visual assessment of alignment while performing a plie in par-allel and in turnout identified side-to-side differences in 23.08% and 26.92% respectively of the injured dancers. When assessing strength with the hand dynamometer, a significant difference was found between right and left gluteus maximus strength in percent body weight (P<.001) and right and left gluteus medius strength in percent body weight (P = .025). For the 2015 season, gluteus maximus side-to-side differences were found in 80% (n = 5) of injured dancers. When assessing alignment us-ing MyoMotion Kinematic Analysis, right and left hip external rotation in turnout was found to be significant (P = .004).CONCLUSIONS: Professional ballet dancers are at an increased risk for lower extremity injuries because the current preseason screen used by profes-sional ballet companies only identifies 25.64% of side-to-side differences. Adding more objective screening equipment such as the hand dynamom-eter and 3-D motion analysis is recommended to improve the preseason screen and to better identify dancers at risk for injury.CLINICAL RELEVANCE: The current preseason screen that is used for profes-sional ballet does not appear to be adequately identifying dancers who are at risk for injury. However, by adding more objective tests such as dy-nametric strength measurements of the gluteal muscles and 3-D analysis of common dance moves should improve the preseason screens to iden-tify at risk performers.

OPO185THREE-DIMENSIONAL METATARSAL PROTRUSION DISTANCE: A POTENTIAL RISK FACTOR FOR BUNIONMichael Rodriguez, Kara Pioske, Ward M. GlasoeUniversity of Minnesota, Minneapolis, MinnesotaPURPOSE/HYPOTHESIS: First metatarsal protrusion distance (MPD) has been studied as contributing to bunion formation. A bunion (hallux val-gus) is a deformity that presents as a lateral deviation of the hallux with a corresponding medial deviation of the first metatarsal. To date, the ma-jority of investigations have used radiographic (2-D) methods, with most reporting a long first metatarsal as a characteristic of hallux valgus. This study measured MPD using a 3-D computer image reconstruction mod-eling process, testing the null hypothesis of no group difference in women with hallux valgus compared to controls.NUMBER OF SUBJECTS: Twenty-nine women (mean ± SD age, 59 ± 17 years) were divided into groups (controls, n = 10; hallux valgus, n = 19) based on the hallux valgus angle. An angle larger than 15° indicated hallux valgus.MATERIALS/METHODS: Magnetic resonance images of the foot were acquired in weightbearing on all women. The images were reconstructed into vir-tual bone model data sets. Two examiners, using a computer tool, mea-sured the distance (length) of the first and second metatarsals in rela-tion to the navicular. Relative difference between length measures was recorded as MPD. In addition to a reliability analysis, an independent t test assessed for group differences in demographics (age and BMI) and foot posture (hallux valgus and intermetatarsal angles), and for the mea-surement of MPD.RESULTS: Demographics were not different (P value was approximately .46), while the hallux valgus and intermetatarsal angles were different (P<.01) between groups. The interexaminer measurements of MPD were reliable (ICC = 0.99; SEM, 0.78 mm), and averaged approximately –2.0 mm regardless of group assignment. The negative value indicates that length of the first metatarsal was short compared to the second metatar-sal. There was no group difference (P = .89) in MPD.CONCLUSIONS: This study used a novel 3-D method to calculate MPD in subjects with and without hallux valgus. Finding no group difference, and that the mean relative length of the first metatarsal was short with hallux valgus runs counter to the existing literature. While unexpected, the re-sult may prompt research to continue to investigate MPD as a character-istic of hallux valgus with 3-D methods, instead of relying solely on single plane radiograph reports.


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ing interventions.NUMBER OF SUBJECTS: Sixty.MATERIALS/METHODS: Utilizing a randomized controlled trial, partici-pants were allocated to 1 of 3 groups: IASTM, stretching and control. The IASTM group received treatment for 2 minutes in a direction paral-lel to the muscle fibers [3]. The stretching group was instructed in a wall stretch with the knee extended and then flexed for 3 bouts of 30 seconds each. DF measurements were assessed before and after interventions to analyze immediate effects of interventions in weight bearing (WB) versus nonweight bearing (NWB) conditions. The outcome measures included the Weight Bearing Lunge Test (WBLT) using a digital inclinometer [4] as well as the Modified Root Position 1 (MRP1) with the knee extended at 0° and the Modified Root Position 2 (MRP2) with the knee flexed to 90° using a goniometer [5]. Paired t tests were conducted to evaluate with-in-group significance. Between-group comparisons were analyzed using 2-way analyses of variance (ANOVAs). Post hoc Tukey’s analyses were uti-lized to compare mean changes between the groups.RESULTS: No significant differences in ROM were identified between groups at baseline. A group-by-time interaction revealed statistically sig-nificant changes in ankle DF in the WBLT (P = .011) and MRP2 (P = .031) favoring the stretching and IASTM groups. No significant chang-es were observed with the knee extended to 0° for all groups (P = .943). Specifically, a significant difference was identified with the IASTM inter-vention for both the WBLT (P = .018) and the MRP2 (P = .045) measures when compared to controls. Significant improvements were also found for the stretching group, however, only in the WBLT position (P = .034). No significant difference existed between the intervention groups. No within-group significant differences were identified in the control group.CONCLUSIONS: IASTM produced a statistically significant increase in DF ROM in WB and NWB conditions compared to control as demonstrat-ed with the WBLT and MRP2. Stretching revealed a statistically signif-icant improvement in WB with the WBLT. It is possible to suggest that the soleus was attributed to the greatest influence on the increase in ROM based on significant results with the knee in flexed positions. The results also suggest that IASTM was more effective than stretching at improv-ing ankle DF ROM in NWB conditions based on MRP2 measurements.CLINICAL RELEVANCE: Foot and ankle pathologies are inherently associat-ed with WB stresses and limited DF. Since IASTM and stretching both revealed significant increases in ROM with the WBLT, these interven-tions can be considered viable treatment options for increasing DF ROM.

OPO189THE USE OF PAIN NEUROSCIENCE EDUCATION IN OLDER ADULTS WITH CHRONIC BACK AND/OR LOWER EXTREMITY PAINAdam Rufa, Katherine Beissner, Michelle DolphinPhysical Therapy Education Department, SUNY Upstate Medical University, Syracuse, New YorkPURPOSE/HYPOTHESIS: Chronic pain is highly prevalent among older adults and contributes to disability [1,2] and increased health service utilization [3]. Analgesic options are limited due to high levels of comorbidity and the potential for adverse drug reactions [4]. Pain Neuroscience Education (PNE) has demonstrated effectiveness in reducing pain and improving pain self-efficacy in individuals under 60 years of age [5,6], but there is a paucity of research examining its use with older adults. If PNE has similar effects in older adults, it has the potential to be a useful nonpharmacolog-ical intervention for the older adult population. The purpose of this pilot project is to determine whether older adults with chronic pain conditions are receptive to PNE and to determine potential efficacy of this treatment in terms of pain intensity, kinesiophobia, and mobility.NUMBER OF SUBJECTS: Twenty.MATERIALS/METHODS: Twenty subjects, 9 female, aged 65 to 88 (mean age, 73 years) years, reporting low back and/or lower extremity pain on most days for at least 3 months attended 2 study sessions. The first session started with data collection including demographic information, Tampa

Blair J. Packard, Robert L. Whipple, Paul JamesEast Valley Physical Therapy and Aquatic Rehabilitation, Mesa, Arizona; Physical Therapy, A. T. Still University of Health Sciences, Gilbert, ArizonaPURPOSE/HYPOTHESIS: To examine the internal consistency of a modified version of the Lower Extremity Functional Scale (mLEFS) for patients following total knee arthroplasty at the initial examination and at dis-charge for physical therapy services. The differences between the original LEFS (oLEFS) and the mLEFS were several items on the oLEFS such as running on even and uneven ground, making sharp turns while running fast, hopping, and walking a mile were eliminated in the mLEFS; as these items may not be appropriate physical therapy goals for older adults at an outpatient facility. Wording changes were also made to the instructions to make it easier for patients to answer the questions without assistance. The total number of questions for the mLEFS was reduced from 20 in the original instrument to 15, with a maximum score of 60.NUMBER OF SUBJECTS: This was a retrospective study of 66 patients through a systematic chart review.MATERIALS/METHODS: Patients were included if the participant had under-gone a total knee arthroplasty or a revision surgery. Patients also had to have completed the mLEFS a minimum of twice to be included in the study: once at initial examination and once at discharge. Cronbach’s al-phas were calculated for both pretest and posttest of the mLEFS to esti-mate internal consistency of the scale. A dependent-samples t test was calculated to assess the significance of the difference between the pretest and posttest scores. An exploratory factor analysis was also conducted to assess the dimensionality of the revised scale.RESULTS: The sample consisted of 40 females and 26 males. Average ± SD age of the patients was 69.77 ± 9.29 years. The average ± SD number of visits was 12.03 ± 4.54. The mean score for the pretest was while the mean score for the posttest was. The mLEFS posttest score was significantly higher (46.94 ± 8.66) than the pretest score (33.97 ± 12.46; P<.001), At the initial examination, Cronbach’s alpha was .93, which is considered high. For the posttest examination, Cronbach’s alpha was .89. Results of the exploratory factor analysis suggested the presence of at least 2 dimen-sions, 1 associated with activities of daily living, and the other with walk-ing-related tasks.CONCLUSIONS: The mLEFS exhibited high internal consistency and re-vealed a significant change in pretest to posttest administration; how-ever it appears that this scale may be optimally interpreted using more than 1 scale score. Preliminary analysis of the mLEFS in patients with to-tal joint arthroplasty suggests that this truncated scale may be more ef-ficient and useful in this population than the oLEFS. Further investiga-tion is ongoing.CLINICAL RELEVANCE: We believe the mLEFS is an improvement on the oLEFS because items such as running on even and uneven ground, mak-ing sharp turns while running fast, hopping, and walking a mile, which are inappropriate for older adults recovering from total knee arthroplasty. We believe the instructions were improved to make it easier for patients to answer the questions without assistance.

OPO188EFFICACY OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION IN COMPARISON TO GASTROCNEMIUS-SOLEUS STRETCHING FOR DORSIFLEXION RANGE OF MOTIONCarrie Rowlett, William J. Hanney, Jordon Holland, Morey J. Kolber, Xinliang Liu, Michael MasaracchioPhysical Therapy, University of Central Florida, Orlando, FloridaPURPOSE/HYPOTHESIS: Limited dorsiflexion range of motion (DF ROM) is associated with numerous injuries that can alter or limit function [1]. Evidence supports stretching interventions to increase DF ROM [2]; however, limited research is available on the efficacy of Instrument-Assisted Soft Tissue Mobilization (IASTM). This study investigates IASTM and its impact on DF ROM in comparison to traditional stretch-


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DISCUSSION: This case describes clinically meaningful improvements in outcomes in a patient with chronic low back pain and signs of a central-ized pain condition in whom modifications were made to a treatment ap-proach guided by clinical practice guidelines.REFERENCES: 1. Delitto A, George SZ, Dillen LV, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain clinical prac-tice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42: A1-A57. 2. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69:153-166. 3. Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Gatchel RJ. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012;12:276-285. 4. Nijs J, Meeus M, Van Oosterwijck J, Roussel N, De Kooning M, Ickmans K, Matic M. Treatment of central sensitization in patients with “unexplained: chronic pain: what options do we have? Exp Opin Pharmacother. 2011;12:1087-1098. 5. Noehren B, Dailey DL, Rakel BA, Vance CG, Zimmerman MB, Crofford LJ, Sluka KA. Effect of trans-cutaneous electrical nerve stimulation on pain, function, and quality of life in fibromyalgia: A double-blind randomized clinical trial. Phys Ther. 2015;95:129-140.

OPO191THE EFFICACY OF STRETCHING EXERCISES TO REDUCE POSTERIOR SHOULDER TIGHTNESS ACUTELY IN THE POSTOPERATIVE POPULATION: A SINGLE-BLINDED RANDOMIZED CONTROLLED TRIALPaul Salamh, Morey J. Kolber, Eric J. Hegedus, Chad E. CookOrthopedics, Duke University, Durham, North Carolina; Nova Southeastern University, Fort Lauderdale, Florida; High Point University, High Point, North CarolinaPURPOSE/HYPOTHESIS: Shoulder stiffness is a common postoperative com-plication among individuals having undergone shoulder surgery, with an incidence of persistent postoperative shoulder stiffness ranging from 1.5% to 11.1% [1-3]. Of those with postoperative shoulder stiffness requiring a secondary capsular release, 95.5% exhibited impaired glenohumeral in-ternal rotation; implying a contribution of the posterior shoulder struc-tures [2]. A number of studies have investigated the effectiveness of stretching exercises for improving overall shoulder range of motion in in-dividuals with posterior shoulder tightness (PST) [4-7] and findings sup-port improvements in both range of motion and complaints of impinge-ment (with symptomatic populations) using exercises such as the sleeper stretch [4], the cross-body stretch [5], and horizontal adduction stretch-ing with and without joint mobilization [8]. However, none of the report-ed studies investigated the effectiveness of these stretching methods on shoulder stiffness in a postsurgical cohort. The purpose of this study was to determine the short term efficacy of 2 separate stretches designed to re-duce PST in the postoperative population.NUMBER OF SUBJECTS: Sixty-three.MATERIALS/METHODS: The study was a randomized control trial in which patients who had arthroscopic shoulder surgery were assigned to 1 of 3 groups (horizontal adduction, modified sleeper, or control). Dependent variables included measurements of internal rotation (IR) mobility, side-lying PST, pain, and the QuickDASH. Following the physical therapy ini-tial evaluation, subjects were instructed to perform the allocated inter-vention until their first follow-up appointment 48 to 72 hours following the initial PT visit.RESULTS: The study enrolled 63 patients (mean age, 51 years). Between group analyses of dependent variables revealed significant differences within PST measurements (P = .005) taken at baseline and follow-up (48-72 hours) favoring horizontal adduction stretching. Post hoc testing dem-onstrated superiority of horizontal adduction stretching over both the modified sleeper group (P = .01) and control (P = .002). There was no sig-nificant differences seen between groups with regards to IR, pain scores,

Scale of Kinesiophobia (TSK), Pain Disability Index (PDI), Resilience Scale (RS-14) and Gait Speed. Subjects then received an approximate-ly 60-minute, semi-standardized PNE session. Between sessions they were asked to read a booklet reinforcing the information from the ed-ucation session. The second session occurred 2 weeks later and began with a review of the PNE and provided an opportunity for subjects to ask questions and express their experience. Immediate posttesting included the TSK, PDI, Gait Speed and the PNE Acceptability Scale (PAS). Data were analyzed descriptively and paired t tests were used for prepost test comparisons.RESULTS: All subjects reported a positive perception of the educational ses-sions and universally indicated that, the information was easy to under-stand, interesting and clear. All but 2 subjects felt that they learned some-thing new and 2 subjects felt that the sessions were too short. Eighteen subjects believed most of the information and 2 believed some of it. Subjects universally felt that the education would be helpful to people in pain and all 20 would recommend PNE to a friend in pain. There was a statically significant reduction in PDI (P = .001) and TSK (P = .002) scores after PNE. There were no changes in gait speed.CONCLUSIONS: Adults over the age of 65 are able to understand PNE and find it useful. The educational sessions also show potential efficacy for re-ducing disability and kinesiophobia.CLINICAL RELEVANCE: There is a high prevalence of chronic pain in adults over the age of 65. These results suggest that PNE may be an effective in-tervention for treating chronic pain in this population.

OPO190TREATMENT MODIFICATIONS IN THE PHYSICAL THERAPY MANAGEMENT OF A PATIENT WITH CHRONIC LOW BACK PAIN AND SIGNS AND SYMPTOMS OF CENTRALIZED PAIN: A CASE REPORTEstey Ruppal, Stephanie Wickham, Joel E. BialoskyPhysical Therapy, University of Florida, Gainesville, Florida; VA Medical Center, Gainesville, FloridaBACKGROUND AND PURPOSE: Central sensitization is believed to play a role in the transition from acute to chronic pain, as well as contribute to the sustainment of chronic pain. Signs and symptoms of centralized pain are hallmark characteristics of some chronic pain conditions including a sub-group of individuals with chronic low back pain necessitating treatment modifications. The purpose of this case report is to describe modifications to clinical practice guidelines in the physical therapy management of a patient with low back pain and signs and symptoms of centralized pain.CASE DESCRIPTION: The patient was a 52-year-old woman who present-ed to physical therapy with a 5-month history of low back and left low-er extremity pain. Her past medical history was significant for fibromy-algia, migraines, and irritable bowel syndrome. The patient completed the Central Sensitization Inventory during her initial visit and scored a 71/100. Her score on the Central Sensitization Inventory along with her past medical history of fibromyalgia, migraines, and irritable bow-el syndrome suggested a centralized pain component to her clinical presentation. Furthermore, she scored a 20/24 on the Fear-Avoidance Beliefs physical activity subscale indicating a potentially poor progno-sis for recovery. The patient was classified using the Orthopaedic Section of American Physical Therapy Association’s clinical practice guidelines into the categories of chronic LBP with movement coordination impair-ments and chronic LBP with generalized pain. Treatment was provided as directed by the guidelines. Important modifications included the use of pain neuroscience education, graded activity, graded exposure, and ac-tivity pacing. Additionally, a Transcutaneous Electrical Nerve Stimulation (TENS) unit was provided for use at home during functional activities as this has been shown to positively alter centralized pain.OUTCOMES: Key outcomes included fear avoidance beliefs and activity as measured by a pedometer. The patient was seen for 3 physical therapy sessions over 6 weeks. Clinically meaningful improvements were observed in both physical activity and fear-avoidance beliefs.


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OPO193THE CORRELATION BETWEEN PECTORALIS MINOR MUSCLE LENGTH AND ROTATOR CUFF STRENGTH USING A COMBINATION SQUARE AND BASELINE PUSH-PULL DYNAMOMETERStephanie Saltarelli, Margaret Vieria, Alexia Kwiatkowski, Ayse Ozcan Edeer, Valerie OlsonDoctor of Physical Therapy Program, Dominican College, Orangeburg, New YorkPURPOSE/HYPOTHESIS: The chronically tight pectoralis minor muscle pulls the scapula into elevation and protraction by its attachment to the cora-coid processes. This contributes to grossly altered shoulder girdle kinemat-ics by directly interfering with scapular displacement and glenohumeral joint positioning which further interferes with the resting length-tension relationship of the rotator cuff musculature. The aim of this research is to determine whether a relationship between pectoralis minor length and ro-tator cuff strength exists. Our hypothesis is that a shortened pectoralis mi-nor muscle is associated with decreased rotator cuff strength.NUMBER OF SUBJECTS: Forty-six young heathy college students (25 male, 21 female) aged 26.4 + 5.0 years.MATERIALS/METHODS: Three researchers collected the data, and each was assigned to 1 specific component to measure consistently (researcher 1 measured pectoralis minor length, researcher 2 measured rotator cuff strength, and researcher 3 measured scapular displacement). The in-formed consent and demographic information were collected at the ini-tial administration. A combination square was used to measure pectoralis minor length in standing with subject against the wall, from the anterior tip of the acromion to the wall. A Baseline handheld push-pull dynamom-eter was used to quantify strength of shoulder external rotators, internal rotators, and abductors. A standard tape measure was used to measure scapular displacement from midline to inferior angle at rest, 90° and 180° of scaption. Pearson product-moment correlation coefficient was used for data analysis.RESULTS: The Pearson correlation coefficient at 95% confidence level be-tween pectoralis minor length and shoulder internal and external rota-tor, and abductor strength showed a statistical significant moderate to strong positive correlations (r = 0.552, P<.01; r = 0.619, P<.01; r = 0.542, P<.01, respectively). Pectoralis minor length and scapular displacement at rest, 90°, and 180°, also showed statistically significant weak to mod-erate positive correlations (r = 0.298, P<.01; r = 0.259, P<.01; r = 0.301, P<.01, respectively).CONCLUSIONS: Results of this study show correlation of pectoralis minor length and the strength of the rotator cuff and scapular displacement. Assessing the pectoralis minor length as a component of shoulder evalu-ation may enhance clinical outcomes. We thus recommend that physical therapists consider a pectoralis minor assessment in the plan of care that intends to rehabilitate and strengthen rotator cuff musculature.CLINICAL RELEVANCE: It is important to consider the dynamic role of pecto-ralis minor length in patients who demonstrate postural mal-alignment and shoulder rotator cuff problem. Restoring optimal pectoralis minor length will restore optimal kinematics of the shoulder girdle which will create better positioning for length-tension relationships of the rotator cuff musculature.

OPO194SOFT TISSUE MOBILIZATION VERSUS ECCENTRIC EXERCISE FOR THE TREATMENT OF TENDINOSISJohn P. Sanko, Nicholas Laurente, Jesse Myers, Robby Ondevilla, Justin J. RamalhoPhysical Therapy, University of Scranton, Scranton, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose of this systematic review was to deter-mine the effectiveness of soft tissue mobilization compared to eccentric exercise in the treatment of tendinosis in terms of pain reduction and functional outcomes.

or QuickDASH scores measured at baseline and follow-up (P>.05).CONCLUSIONS: The horizontal adduction stretch is more effective at reduc-ing acute PST in the postoperative shoulder population when compared to the modified sleeper stretch and no stretch at all. Knowledge of effica-cious stretching methods may serve to reduce the potential morbidity as-sociated with postoperative stiffness.CLINICAL RELEVANCE: Postoperative shoulder stiffness, particularly PST, has been linked to complications following procedures. This study dem-onstrates that addressing PST early utilizing the horizontal adduction stretch among this population can help to reduce postoperative shoulder stiffness without increasing pain or decreasing overall function.

OPO192TASK-SPECIFIC MOVEMENT TRAINING: EFFECT ON LOWER EXTREMITY KINEMATICS, PAIN, AND ACTIVITY PARTICIPATION IN FEMALES WITH PATELLOFEMORAL PAINGretchen B. Salsich, Barb Yemm, Angela Reitenbach, Catherine E. Lang, Linda R. Van DillenPhysical Therapy, Saint Louis University, St Louis, Missouri; Program in Physical Therapy, Washington University School of Medicine, St Louis, MissouriPURPOSE/HYPOTHESIS: Dynamic knee valgus (DKV), a movement pattern characterized by increased hip adduction, hip internal rotation and knee external rotation, has been linked to pain in females with chronic patello-femoral pain (PFP). Optimizing movement during daily activities may be an effective rehabilitation strategy. This pilot study investigated wheth-er a novel, task-specific movement pattern training intervention would improve hip and knee kinematics, pain, and activity participation in fe-males with PFP.NUMBER OF SUBJECTS: Twenty-three females with PFP of approximately 2 months’ duration who demonstrated observable DKV during single limb squat (mean ± SD age, 21.8 ± 3.7 years; BMI, 22.2 ± 2.0 kg/m2; pain du-ration, 4.1 ± 3.4 years). Average pain (past week) was 3.7 ± 1.0 (numeric pain rating, 0-10).MATERIALS/METHODS: The intervention was delivered 2 times per week for 6 weeks and consisted of practice of daily activities with a focus on minimizing DKV. Activities were selected and progressed based on sub-jects’ interest and ability to minimize DKV without an increase in pain. Minimal feedback was given, once subjects demonstrated knowledge of key movement concepts. Primary outcomes were kinematics (hip adduc-tion, hip internal rotation, knee external rotation) at peak knee flexion during a single limb squat, pain (visual analog scale [0-100]: maximum during past week), and activity participation (Patient-Specific Functional Scale, 0-10, 10 is no limitation). Outcomes were assessed (1) before treat-ment (2 baselines, separated by 6 weeks), (2) posttreatment, and (3) 4 weeks posttreatment. Comparisons were made using mixed model, re-peated measures analysis of variance tests (P<.05).RESULTS: For all outcomes, differences during the treatment phase (base-line 2 to posttreatment) were greater than differences during the control phase (baseline 1 to baseline 2) (P<.0001). Following treatment, improve-ments were detected in hip adduction (8.4° ± 6.7° versus 17.9° ± 5.8°), hip internal rotation (–7.5° ± 6.1° versus –0.7° ± 5.6°), knee external rota-tion (9.1° ± 4.9° versus 4.2° ± 5.3° of internal rotation), pain (17.1 ± 14.4 versus 42.7 ± 20.8) and activity participation (8.5 ± 0.9 versus 5.9 ± 1.3). Improvements in all outcomes remained at 4 weeks posttreatment com-pared to baseline 2.CONCLUSIONS: Lower extremity movement (hip and knee kinematics), pain, and activity participation improved in females with PFP following a 6-week task-specific, movement pattern training intervention. A larger clinical trial to substantiate these findings is warranted.CLINICAL RELEVANCE: A physical therapy intervention comprised solely of movement pattern training during patient-selected tasks may yield posi-tive outcomes in young women with PFP.


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trial in a variety of positions, including prone, right, and left side planks. After proper form was briefly demonstrated, subjects completed each plank position to task failure. For each plank variation, 2 authors blinded to one another began a timer once the intended testing position was as-sumed. Time was stopped as soon as any body part other than the feet or forearm(s) touched the mat.RESULTS: Mean core endurance was found to be 93 seconds in prone plank, 40.58 seconds in left side, and 41.41 seconds in right side plank. Independent t tests revealed significant differences between sex, those with and without plank experience, and BMI of male versus female participants. No significant difference was observed for age, functional health, and exercise characteristics. Interrater reliability was found to be strong among prone plank, left side plank, and right side plank positions.CONCLUSIONS: Assessment of core endurance via prone and side planks was found to have high interrater reliability. Additionally, there were found to be statistically significant differences in plank hold times across sexes, in those with prior plank exposure, and according to BMI. As iden-tified in this study, plank hold times were lower in this population than in many published research studies: specifically when compared to those measuring plank hold time in higher-level athletes. Clinicians should rec-ognize this when assessing core endurance in a general population. Data collected for a more heterogeneous population may better represent those persons most often seen in clinic, thereby optimizing clinical reasoning and decision making for clinicians.CLINICAL RELEVANCE: To the knowledge of the authors, this is the first study of normative data for prone and side planks in a population more repre-sentative of the typical adult population seeking outpatient therapy ser-vices. When aggregated with existing core endurance data, the findings from this study may assist in better describing normative core endur-ance in healthy individuals of varied activity levels. Minimal detectable change as reported in this study may assist in appreciating the magni-tude of change required to declare a true improvement in core endur-ance. Future research to establish involved musculature in prone and side planks is indicated.

OPO196THERAPEUTIC MANAGEMENT AND COMPLICATIONS IN PEDIATRIC CONGENITAL FEMORAL DEFICIENCY: A CASE REPORTJoel Sattgast, Lisa Nau, Heather StremlerPhysical Therapy, Davenport University, Grand Rapids, Michigan; Lynden Family Physical Therapy, Lynden, WashingtonBACKGROUND AND PURPOSE: Congenital abnormalities involving limb length discrepancy of the femur affect pediatric gross motor, neuromuscular, and social development. Currently, multidisciplinary management is used to optimize function postnatally and into adolescence. However, ther-apeutic management is poorly reported and minimal research exists to guide best-practice therapeutic intervention. This case report identifies and describes the application of, and outcomes associated with, thera-peutic management of pediatric congenital femoral deficiency in order to contribute to and promote further discourse to develop best-practice strategies toward managing this diagnosis from a physical, psychosocial, cognitive dimension as well as patient-family-empowerment related to self-care management.CASE DESCRIPTION: A 4-year-old girl presented for rehabilitation follow-ing limb lengthening with external fixator secondary to congenital femo-ral deficiency (CFD) with greater than 40° loss of knee extension limiting weight bearing, mobility, and ambulation. Evaluation included neuro-muscular (strength, range of motion, circumference, balance, gait, move-ment control) and integumentary (wound care) assessment, as well as communication with interdisciplinary care providers, pediatric surgeon, and family. Intervention consisted of 6 weeks of soft tissue stretching and mobilization, joint mobilization, dyna-splint use, self-care management education, and creation and implementation of a “Brave Chart” for behav-ior modification and reinforcement.

NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: A literature search (2006-2016) of CINAHL, MEDLINE, Web of Science, Science Direct, and PubMed using the search terms: (tendinosis OR tendinopathy) AND (ASTYM OR eccentric exer-cise). Selection criteria: RCTs, human subjects, and English language. Two reviewers independently assessed each article for methodological quality and came to consensus based on PEDro scoring guidelines.RESULTS: A total of 508 articles were screened for eligibility. Following de-tailed appraisals, 7 RCTs fulfilled criteria. PEDro scores ranged from 6 to 9/10 (average, 7.3). Samples ranged from 16 to 120 subjects (430 to-tal) with chronic tendinopathy pathology in the shoulder, elbow, knee, and heel cord across all studies. Ecc was performed for 3 sets of 15 repe-titions for 1.67 times per day, 2 to 7 days per week, averaging 9.67 weeks duration (4-12 weeks). ST was performed for 2.33 times per week aver-aging 9.33 weeks duration (4-12 weeks). Primary outcomes included the DASH, VISA-A, and VAS. No adverse events were reported. There were statistically significant between-group improvements noted in function-al outcome measures (VISA-A and DASH) following Ecc and ST versus Ecc alone in 2 studies. There were statistically significant between-group improvements noted in pain (VAS) following Ecc versus concentric ex-ercise in 1 study. There were statistically significant improvements not-ed in functional outcome measures (VISA-A) following Ecc in 1 study. There were no statistically significant between-group improvements not-ed in functional outcome measures (VISA) following Ecc versus surgery in 1 study. There were no statistically significant between-group improve-ments noted in functional outcome measures (VISA-A) following Ecc ver-sus heavy slow resistance in 1 study. There were no statistically significant between-group improvements noted in pain (VAS) following ST versus Therapeutic Exercise in 1 study.CONCLUSIONS: There is moderate to strong evidence in support of an inter-vention that includes Ecc versus ST alone for improving pain and func-tional outcome scores in persons with chronic tendinopathy. Ecc and ST together have an advantage over Ecc or ST alone. Limitations included small samples and a lack of blinding participants. Future RCTs should focus on an optimal dose of Ecc as well as well-defined ST technique for treating chronic tendinopathy.CLINICAL RELEVANCE: The outcomes for Ecc and ST together appear supe-rior compared to other forms of treatment for improving functional out-comes in adults with chronic tendinopathy. Effective treatment protocols use Ecc, for 3 sets of 15 repetitions, and ST 4 to 5 days per week for 9 weeks. Implementing interventions consisting of Ecc and ST are safe and feasible methods for treating chronic tendinopathy.

OPO195CLINICAL UTILITY AND RELIABILITY OF CORE ENDURANCE ASSESSMENT IN A HEALTHY, NORMATIVE POPULATIONLauren K. Sara, Michael O’Hara, Lucia DeLisa, Steven M. JacksonMidwest Orthopaedics at Rush, Chicago, Illinois; Good Shepherd Penn Partners, Philadelphia, Pennsylvania; University of Chicago Hospital, Chicago, Illinois; Orange Park Medical Center, Orange Park, FloridaPURPOSE/HYPOTHESIS: The potential benefits of core endurance for the con-servative management of spine and lower extremity conditions has been well established in the literature. These studies often limit their ability to describe a general population by selecting young, athletic individuals. Further, proposed techniques often lack in reproducibility, clinical utili-ty, and robust statistical findings. The purpose of this study was to collect normative core endurance data for healthy individuals of varied age, sex and activity levels. A secondary aim was to establish preliminary reliabil-ity data for quantification of core endurance.NUMBER OF SUBJECTS: One hundred sixteen.MATERIALS/METHODS: All subjects completed a health intake form and SF-12 questionnaire prior to the study. Subjects then completed a practice


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gression was defined as an increase of at least 1 in the WORMS score for patella and/or trochlear cartilage lesions over the one-year time peri-od. Group differences were assessed using an independent t test (P≤.05).RESULTS: There were no group differences in demographics. Mean base-line ankle contribution to TSM during STS task was significantly lower in PFJ OA progressors (14%) than nonprogressors (20.9%) (P = .048). Although not significant, mean baseline hip and knee contributions were 4.3% and 4.5% higher, respectively, in progressors when compared to nonprogressors.CONCLUSIONS: PFJ OA progressors exhibited altered ankle joint compensa-tion strategies at baseline when compared to nonprogressors.CLINICAL RELEVANCE: Our findings suggest that altered ankle joint compen-sations may play a role in PFJ OA progression.

OPO198SUCCESSFUL OUTCOME AFTER MONTHS OF DEBILITATING POSTCONCUSSION SYNDROME USING CERVICOGENIC AND VESTIBULO-OCULAR TREATMENTGregory Schiller, Airelle O. GiordanoPhysical Therapy, University of Delaware, Newark, DelawareBACKGROUND AND PURPOSE: To explain a comprehensive plan of care for the management of a patient with postconcussion syndrome (PCS). Symptoms were cervicogenic and vestibulo-ocular, restricting tolerance to driving and working as a manager of a restaurant, following a motor vehicle collision (MVC); the second leading cause of TBI.CASE DESCRIPTION: A 62-year-old man presented 4 months post-MVC with postconcussion symptoms including cervical pain, headaches (HA), diz-ziness and episodes of disorientation/vomiting. Disorientation/vomiting was concerning and occurred more than 40 times post-MVC. Physician workup suggested episodes were likely migrainous or seizures. Treatment of cervical/occipital nerve injections and PT, concentrating on balance were unsuccessful. PMH included stroke following cardiac valve surgery, Graves’ Disease, migraines and motion sickness. Evaluation included as-sessment of the cervical spine and vestibulo-ocular systems to determine subtypes present. Activity-Specific Balance Confidence Scale (ABCS) 41 (low-level of physical functioning), Dizziness Handicap Inventory Scale (DHIS) 56 (severe), Headache Disability Index (HDI): 16 (mild). Neuro/vascular screen: (negative) except for diminished L C7 myotome. Cervical testing: (negative) ligamentous testing, (positive) TTP of B UT and sub-occipitals, with palpation decreasing dizziness and HA. AROM WNL ex-cept slight limitation in B rotation and SBing, joint mobility correlated with AROM. Cervical Joint Position Error (JPE): R 1 error greater than 7 cm, L 3 errors greater than 7 cm. Cervical flexion endurance test: 19 seconds. Oculomotor testing: (positive) VOR, VOR cancellation, verti-cal saccades, left diagonal and horizontal smooth pursuits, all with diz-ziness. Motion Sensitivity Quotient: 31 (severe). Balance: SLS less than 3 seconds, unable to complete BESS test. Vestibular Testing: (negative) testing for BPPV. Treatment: Cervical spine: STM, stretching/joint mobs, JPE training and neck flexor endurance training. Oculomotor training: VOR, VOR cancellation, saccades, smooth pursuit and optokinetic drills, working from sitting in a quiet room to standing with narrow base of sup-port (NBOS) and busy backgrounds like a disco ball. Motion Sensitivity: Educated on a HEP utilizing oculomotor exercises and online videos at home. Balance: NBOS, tandem stance and SLS progressing to compliant surfaces and eyes closed.OUTCOMES: Over 41 visits; 7 months, vomiting ceased, occasional disori-entation lasting less than 10 seconds, reduction in dizziness to 1 to 2/10, minimal neck pain and HA frequency less than 2 times per weeks that he was able to modulate with self-STM. BESS: 34. Neck flexor endur-ance: 32 seconds, JPE L improved. Vestibulo-ocular testing: all (nega-tive). ABCS: 91 (MDC, 13), DHIS: 28 (MCID, 18), HDI: 4 (MCID, 29). Tolerance to bending/lifting, driving, and multitasking at work returned to pre-MVC levels.DISCUSSION: In order to manage PCS effectively, recognition of clinical sub-types and matching them with targeted treatment approaches is pivot-

OUTCOMES: Improved soft tissue and joint mobility, increased weight bear-ing functional use, and decreased emotional distress, combined with im-proved self-care management and brace compliancy, were observed throughout the 6-week period. In particular, range of motion improved from greater than 40° loss of flexion to lacking only 6° from full extension. Functionally, ambulation was independent of wheeled walker at home and community distances.DISCUSSION: Biopsychosocial consideration should occur within the re-habilitation environment to consider the multidimensional approach to managing CFD. Clear objective goals and outcome assessment should be provided to the patient, family, surgeon, and other interdisciplinary med-ical professionals. Additionally, patients in the pediatric population may require innovative encouragement and reinforcement for intervention compliancy.REFERENCES: Paley D Standard SC. Lengthening reconstruction sur-gery for congenital femoral deficiency. In: Rozbruch SR, Ilizarov S, eds. Limb Lengthening and Reconstruction Surgery. New York, NY: Informa Healthcare; 2007:393-428. Monsell FP, Bintcliffe FAC, Evans C, Hughes R. Management of congenital femoral deficiency. Early Hum Develop. 2013;89:915-918. Oppenheim W, Setoguchi Y, Fowler E. Overview and comparison of Syme’s amputation and knee fusion with the van Ness rotationplasty procedure in proximal femoral focal deficiency. In: Herring J, Birch JG, eds. The Child With a Limb Deficiency. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1998. Abdelgawad A, Jauregui J, Standard S, Paley D, Herzenberg J. Prophylactic intramedul-lary rodding following femoral lengthening in congenital deficiency of the femur. J Pediatr Orthop. 2015. Prince DE, Herzenberg JE, Standard SC, and Paley D. Lengthening with external fixation is effective in congenital femoral deficiency. Clin Orthop Relat Res. 2015:3261-3271.

OPO197ALTERED JOINT KINETICS IN PATELLOFEMORAL JOINT OSTEOARTHRITIS PROGRESSION DURING SIT-TO-STANDKatherine Sawyer, Michael A. Samaan, Hsiang-Ling Teng, Sharmila Majumdar, Richard B. SouzaUniversity of California, San Francisco, San Francisco, CaliforniaPURPOSE/HYPOTHESIS: Patellofemoral joint osteoarthritis (PFJ OA) occurs in 64% of adults over the age of 50 years and is known to cause pain and dysfunction in the knee joint. The sit-to-stand (STS) task is a demanding activity of daily living that is performed by healthy adults on average 60 times per day. Studies have shown altered lower extremity mechanics dur-ing the STS task in patients with hip OA and knee OA. Biomechanical as-sessment of the STS task in PFJ OA patients may prove beneficial in un-derstanding the pathomechanics involved in the progression of PFJ OA. We hypothesized that patients that exhibit PFJ OA progression over 1 year would demonstrate altered sagittal plane biomechanical loading at base-line, during the STS task, when compared to nonprogressors.NUMBER OF SUBJECTS: Thirty-three total patients with PFJ OA (Progressors: n = 8; mean ± SD age, 52.5 ± 10.1 years; 1 male; BMI, 24.0 ± 2.3 kg/m2; Nonprogressors: n = 25; age, 54.2 ± 9.5 years; 5 males; BMI, 23.5 ± 3.7 kg/m2).MATERIALS/METHODS: All patients underwent 3-D motion analysis during the STS task at baseline as well as a unilateral knee joint magnetic reso-nance (MR) scan at baseline and one-year follow-up. Lower extremity ki-nematics (250 Hz, VICON) and ground reaction forces (1000 Hz, AMTI) were recorded while patients performed the STS task at a self-selected speed. Sagittal plane hip, knee and ankle joint moments were comput-ed using inverse dynamics (Visual3D) and were normalized to body mass (Nm/kg). The total support moment (TSM) and the 3 individual joint contributions of the hip, knee, and ankle (percent TSM) were calculat-ed. Knee MR images were acquired using a high-resolution 3-D fast spin-echo CUBE sequence. We used the Whole-Organ Magnetic Resonance Imaging Score (WORMS), a semi-quantitative MR based scoring meth-od, to grade patella and trochlear cartilage abnormalities. PFJ OA pro-


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REFERENCES: 1. Fairclough J, Hayashi K, Toumi H, et al. The function-al anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006;208:309-316. 2. Ferber R, Kendall KD, McElroy L. Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. J Athl Train. 2010;45:344-348. 3. Melchione WE, Sullivan MS. Reliability of measurements obtained by use of an instrument designed to indirectly measure iliotibial band length. J Orthop Sports Phys Ther. 1993;18:511-515. 4. Mohr AR, Long BC, Goad CL. Effect of foam rolling and stat-ic stretching on passive hip flexion range of motion. J Sport Rehabil. 2014;23:296-299. 5. Noehren B, Schmitz A, Hempel R, Westlake C, Black W. Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. J Orthop Sports Phys Ther. 2014;44:217-222. 6. Sullivan KM, Silvey DBJ, Button DC, Behm DG. Roller massag-er application to the hamstrings increases sit-and-reach range of motion within 5 to ten seconds without performance impairments. Int J Sports Phys Ther. 2013;8:228-236. 7. Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait retraining empha-sizing step rate manipulation. Int J Sports Phys Ther. 2014;9:222-231. 8. Cheatham SW, Kolber MJ, Cain M, Lee M. The effects of selfmyofas-cial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther. 2015;10:827-838.

OPO200POSTOPERATIVE REHABILITATION FOR AN UNCOMMON INJURY OF THE KNEE: A CASE STUDYMitchell Selhorst, William Rice, Erin BaumannSports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OhioBACKGROUND AND PURPOSE: Chronic instability of the proximal tibiofibu-lar joint (PTFJ) is an uncommon condition and frequently misdiagnosed, accounting for less than 1% of knee injuries [4]. The mechanism of this injury is usually a sports related high-velocity twisting motion of a flexed knee [1,2,4]. Surgical management is controversial with many approach-es causing complications [3,6]. To avoid these complications, surgeons are now utilizing ligament reconstruction to restore stability [3,5]. In cur-rent literature there is no report of aftercare for this procedure. The pur-pose of this case study is to describe postsurgical rehabilitation for an ad-olescent athlete following PTFJ reconstruction.CASE DESCRIPTION: The patient was a 15-year-old female soccer player with reporting left ankle and lateral knee pain over the course of 1 year. The surgeon determined a diagnosis of chronic PTFJ instability and per-formed reconstruction of the PTFJ. Patient presented to physical thera-py evaluation 3 weeks postsurgery with complete resolution of left ankle pain and only mild lateral knee pain. The patient’s parents reported anx-iety symptoms but no medical diagnosis had been made; patient had no other significant past medical history. The patient’s goal was to return to golf as patient reports apprehension with return to soccer. After consult-ing with the surgeon the treating therapists progressed the patient using a modified ACL protocol.OUTCOMES: The outcome measures for this case study were the patient spe-cific functional scale (PSFS), numeric pain rating scale and ability to par-ticipate in golf. The initial PSFS score was 3/30 with the 3 activities be-ing walking, jogging and golf. The initial pain level was 3/10 at left lateral knee. Patient was restricted from sport at that time. Three months after surgery the patient had significant improvement to 27/30 on the PSFS, 0/10 pain and had progressed to chipping, putting in golf and jogging. Patient was slower than expected on meeting functional milestones due to excessive fear avoidance and decreased activity tolerance.DISCUSSION: The modified ACL protocol was effective in safe treatment for postoperative rehabilitation following PTFJ reconstruction in an ad-olescent athlete. This patient demonstrated some yellow flags which may have slowed progression of rehabilitation. Use of a modified ACL recon-

al. This approach allowed a patient, who was severely restricted at work and driving, to return to all functional activities with minimal limitations.REFERENCES: VA/DoD. Clinical practice guideline for management of con-cussion-mild traumatic brain injury. J Rehabil Res Dev. 2009;46:CP1-CP68. Leddy JJ, Baker JG, Merchant A, et al. Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clin J Sport Med. 2015;25:237-242. Alsalaheen BA, Whitney SL, Marchetti GF, et al. Relationship between cognitive assessment and bal-ance measures in adolescents referred for vestibular physical therapy af-ter concussion. Clin J Sport Med. 2016;26:46-52. O’leary S, Jull G, Van Wyk L, Pedler A, Elliott J. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise-a pilot study. Muscle Nerve. 2015;52:772-779. Broglio SP, Collins MW, Williams RM, Mucha A, Kontos A. Current and emerging rehabilitation for con-cussion: a review of the evidence. Clinics Sports Med. 2015;34:213-231.

OPO199THE EFFECT OF FOAM ROLLING COMPARED TO STATIC STRETCHING ON HIP ADDUCTION RANGE OF MOTIONIan Scott, Nina Kelly, Shawn HuntPhysical Therapy, University of Miami, Coral Gables, FloridaBACKGROUND AND PURPOSE: The effectiveness of foam rolling (FR) to the lateral thigh as an intervention to improve adduction range of motion (ROM) is poorly understood despite its popularity as a treatment ap-proach to address Iliotibial band (ITB) pathology. FR is also commonly used in fitness as a warm-up, cool-down, or mobility exercise.CASE DESCRIPTION: A 23-year-old female physical therapy student with bi-lateral positive Ober Test and bilateral lateral thigh pain, left greater than right, performed static stretching (SS) on 1 lower extremity and FR on the opposite lower extremity. Both interventions were self-administered by the subject for 3 repetitions of 30 seconds, once per day during a 7-day intervention period. ROM was assessed twice each day, first after a 5-min-ute warm-up on a stationary cycle, and again postintervention on each lower extremity. Measurements were also taken on days 12 and 20 to de-termine the duration of each treatment effect. Measurements were re-corded using a modified Ober test described by Reese and Bandy (2003). The test position was marked on a paper template to ensure consistency in position of subsequent measurements. Measurements were recorded in degrees below horizontal via a fluid inclinometer on the lateral femoral epicondyle. The Lower Extremity Functional Score (LEFS) was admin-istered pre and postintervention to assess functional changes in lateral thigh pain characteristics.OUTCOMES: ROM increased from 5° to 25° on the SS yielding a negative Ober test at intervention day 4. The FR extremity ROM improved from 6° to 19°, but failed to achieve a negative Ober test. At days 12 and 20 pos-tintervention, the SS extremity remained at 23° both days, while the FR extremity remained at 13° and 12° of ROM respectively. LEFS scores im-proved from 50/80 to 69/80 postintervention; however, the subject re-ported persistent pain in the proximal thigh of the FR lower extremity.DISCUSSION: FR and SS both improved ROM, however SS appears to be more effective providing clinical changes in special tests, ROM, and func-tion, and with longer subject retention. ROM gains via SS versus FR are consistent with previous research findings for hip flexion ROM, shoulder external rotation ROM, and plantarflexion ROM. The force applied to the ITB during FR may not provide the biomechanical stress/strain necessary to elicit plastic deformation of the ITB longitudinally as effectively as SS. LEFS scores did not describe unilateral changes, however the subject re-ported a substantial reduction pain on the SS extremity during prolonged sitting after day 2, and pain-free sleeping in sidelying after day 3, which persisted through day 20. Similar improvements were noted on the FR extremity, however symptoms returned by day 10. Further investigation is warranted to confirm the results obtained in this case study, and to ex-amine the contribution of length changes of the Tensor Fascia Latae com-pared to the ITB to improvements in ROM.


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of the severity of the condition, 6 visits may provide the greatest value for the least cost when treating patellofemoral pain syndrome. Additional re-search is necessary to substantiate the findings of this pilot work.CLINICAL RELEVANCE: Fewer visits may result in the greater value for the physical therapy care of patients with PFPS.

OPO202A PORTABLE BRAKE SIMULATOR PROVIDES FEEDBACK ON REACTION TIME FOR A PATIENT WITH A BRAIN INJURY AND TOTAL HIP ARTHROPLASTYWilliam G. Seymour, Kurt Manal, Tara J. ManalPhysical Therapy, University of Delaware, Newark, Delaware; Mechanical Engineering, University of Delaware, Newark, DelawarePURPOSE: Describe the use of a newly developed portable brake simulator (DriveSim; not yet in production) that provided information on visual re-action time and directed the focus of patient care after total hip arthro-plasty (THA) complicated by brain injury.DESCRIPTION: Case study of a 67-year-old man was seen 9 weeks after a motor vehicle accident (MVA) causing: subarachnoid diverticula (SAD), subdural hematomas in the frontal and temporal lobes, L clavicular frac-ture, L distal radial/ulnar fracture, nondisplaced C2 fracture, and R ac-etabular/femoral fracture with posterior hip dislocation. As a result of the trauma to his R lower extremity, he required a THA. After 30 vis-its to outpatient PT (13 weeks post-R THA), the patient was returning to his surgeon to discuss being medically cleared to drive. He reported hav-ing diminished confidence in his ability to return to driving if cleared by his physician.SUMMARY OF USE: The patient completed DriveSim testing which repli-cates an accelerator-to-brake pedal transfer with the R lower extremi-ty. Protocol for DriveSim: patient is seated with R lower extremity start-ing on the accelerator pedal of the portable device. A green light provides the patient with visual feedback to stay on the accelerator. When the light turns red (variable times) the patient must react to lift the foot off the gas (visual reaction time), transfer the limb to the brake and generate approx-imately 200 N of force (National Highway Safety Bureau standard force to stop a vehicle). Previous articles have described similar devices how-ever most do not provide the clinician with information on visual reac-tion time. Average of 5 trials: visual reaction time (0.416 seconds; greater than 2 SD above healthy norm [0.276 seconds]), total time (0.772 sec-onds). Force was met but activities to improve visual reaction time were included in his care to assist with his confidence and return to driving. Random and variable practice over 5 treatments: ball toss and kicking, obstacle courses altered every treatment with visual cues for changes in gait speed and direction, balance tasks with vertical/lateral head move-ments visual cues; no direct practice of break simulation. At his 36th visit (17 weeks post-THA) the DriveSim was repeated (5 trials): visual reaction time (0.378 ± 0.038 seconds), total time (0.728 ± 0.044 seconds). Patient was medically cleared to return to driving by his physician and resumed all driving activities.IMPORTANCE TO MEMBERS: This newly developed portable brake simulator can provide therapists with objective data on: visual reaction to visual stimuli, accelerator-to-brake limb transfer times, and time to generate 200 N of force. Such information could assist with altering a clinician’s plan of care to improve a patient’s confidence and ability to drive.

OPO203SHOULDER TREATMENT IMPROVES NECK FUNCTION AND SYMPTOMS AFTER MULTIPLE FAILED CERVICAL SURGERIESWilliam G. Seymour, Tara J. ManalPhysical Therapy, University of Delaware, Newark, DelawareBACKGROUND AND PURPOSE: Describe a case of chronic neck pain and di-minished function unresolved after multiple surgical procedures. Both pain and function improved with treatment directed at shoulder range of motion and strength.

struction protocol is a promising guideline for this rare condition and sur-gery. More research is necessary to establish evidence based guidelines for treatment.REFERENCES: 1. Goldstein Y, Gold A, Chechik O, Drexler M. Dislocation of the proximal tibiofibular joint: a rare sports-related injury. Isr Med Assoc J, 2011;13:62-63. 2. Hsieh CH, Chen JC. Acute dislocation of the proximal tibiofibular joint. J Orthop Sports Phys Ther, 2009;39:826. 3. Kobbe P, Flohe S, Wellmann M, et al. Stabilization of chronic proximal tibiofibular joint instability with a semitendinosus graft. Acta Orthop Belg. 2010;76:830-833. 4. Nieuwe Weme RA, Somford MP, Schepers T. Proximal tibiofibular dislocation: a case report and review of literature. Strat Trauma Limb Reconstr. 2014;9:185-189. 5. Camarda Abruzzese, A, D’Arienzo A. Proximal tibiofibular joint reconstruction with autoge-nous semitendinosus tendon graft. Tech Orthop. 2014:28. 6. Weinert CR, Jr., Raczka R. Recurrent dislocation of the superior tibiofibular joint. Surgical stabilization by ligament reconstruction. J Bone Joint Surg Am. 1984;68:126-128.

OPO201THE NUMBER OF VISITS NECESSARY TO OPTIMALLY TREAT PATELLOFEMORAL PAIN SYNDROME: A PILOT STUDYMitchell Selhorst, William Rice, Michael J. Jackowski, Todd Degenhart, David WessellsSports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OhioPURPOSE/HYPOTHESIS: As health care costs continue to escalate, payers are examining ways to reduce expenditures. As payment systems evolve un-der the Affordable Care Act, the ability to deliver value to the consumer and payers at the lowest cost is increasingly important [1]. Ascertaining an expected number of treatment sessions to optimally treat patients in physical therapy is important information for all stakeholders including the patient, therapist, and payer. Additionally, severity of symptoms and psychological factors have been found to predict clinical outcomes, and the relevance of these factors for optimal duration of care should be as-sessed [2-5]. Conventionally patellofemoral pain syndrome is treated with 8 to 12 visits; however, to the authors’ knowledge no evidence sup-ports this number of treatments. The aim of this pilot study is to deter-mine the optimal number of sessions necessary to effectively treat pa-tients with patellofemoral pain syndrome.NUMBER OF SUBJECTS: Fifty-six patients (mean ± SD age,14.38 ± 1.59 years; 40 [71.4%] female) with patellofemoral pain were included in this pi-lot trial.MATERIALS/METHODS: The pilot data were pulled from completed cases in 2 research studies assessing physical therapy and patellofemoral pain syn-drome. To establish the appropriate number of visits, we determined the number of sessions necessary to achieve maximal clinically significant functional improvement on the Anterior Knee Pain Scale. The minimal clinically important difference was considered 10 points [6]. To deter-mine if severity of the condition was a factor, we assessed the effect of du-ration of symptoms, initial functional level, and fear avoidance beliefs. The mean number of sessions was calculated for the number of visits nec-essary to achieve maximal functional improvement to determine the ap-propriate number.RESULTS: Of the 56 patients, 41 (73.2%) experienced a clinically significant improvement in function. In the patients who achieved significant func-tional improvement, the mean number of sessions necessary to achieve a maximal clinically significant improvement was 6.3 visits (95% CI: 5.5, 7.2). Severity of condition did not have a significant effect on the number of sessions necessary to achieve maximal functional improvement (dura-tion of symptoms, P = .60; initial functional level, P = .07; and fear-avoid-ance beliefs, P = .29).CONCLUSIONS: Most patients achieved maximal functional improvement sooner than the 8 to 12 visits traditionally prescribed to treat patellofem-oral pain syndrome. The results of this pilot data suggest that regardless


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Erik J. Kust, Jonathan Washatka, Philip W. McClurePhysical Therapy, Arcadia University, Glenside, PennsylvaniaPURPOSE/HYPOTHESIS: Muscle atrophy has been reported in patients with rotator cuff pathology [1]. Presumably, exercise yields positive changes in muscle structure which may be associated with improved strength and function, though this has not been well-studied. Ultrasound (US) im-aging has been used extensively for examining shoulder pathology [2]. However, reliability of shoulder muscle size measurement with US is not well established. A few studies have reported variable reliability, 0.45 to 0.88, of rotator cuff muscle size using US [3,4,5]. Further, the relation-ship between muscle cross-sectional area (CSA) and torque measures is not known. The aim of this study was to establish the reliability of shoul-der muscle CSA using US, examine side-to-side differences and to deter-mine the relationship between size and torque.NUMBER OF SUBJECTS: Nineteen asymptomatic, healthy adults (mean ± SD age, 30.8 ± 11.8 years; 12 male, 7 female; dominant arm: 19 right, 0 left).MATERIALS/METHODS: Supraspinatus and infraspinatus muscle CSA of both shoulders was obtained using US. Multiple scans were performed a mean of 1.9 days apart to establish the intersession reliability. Supraspinatus images were captured in the transverse view at the suprascapular notch identified with the US with subject in a seated position and arm resting on a pillow. The infraspinatus muscle CSA was determined with subject in prone position. Using bony landmarks and a custom made template to standardize the measurement location, serial images of the muscle were obtained and spliced to calculate the CSA. Three scans were performed at each session and averaged. Size measurements (cm2) were then per-formed using ImageJ analysis. Abduction and external rotation torque (normalized to body weight) was calculated using force measures from a handheld dynamometer and moment arm length.RESULTS: The ICC, SEM, and MDC values for the between-session reli-ability for muscle size measurements were as follows: supraspinatus ICC = 0.97; 95% CI: 0.93, 0.99; SEM, 0.3; MDC95, 0.8; and infraspinatus ICC = 0.95; 95% CI: 0.86, 0.98; SEM, 1.3; MDC95, 3.1. The supraspina-tus and infraspinatus mean CSA were not different between the arms (su-praspinatus: right, 7.3 ± 1.7; left, 6.9 ± 1.5; infraspinatus: right, 16.5 ± 5.7; left, 14.3 ± 5.5). The abduction torque and external rotation torque were not strongly related to the muscle size measurements (range of r values = 0.18-0.37).CONCLUSIONS: The results of this study show excellent reliability for supra-spinatus and infraspinatus muscle CSA measurements. There was no dif-ference in the muscle CSA between arms. Correlation between muscle size and torque was not strong. These results need to be further validated in a larger sample size. Future steps include examining the change in muscle size in response to an exercise program.CLINICAL RELEVANCE: Understanding mechanisms associated with pathol-ogy and response to exercise is important to guide practice. Muscle size represents a key variable and US offers a feasible and reliable measure-ment method. Further examination of the relationship between muscle size changes, and functional changes is warranted.

OPO205TRUNK AND PELVIC KINEMATICS OF RUNNERS WITH AND WITHOUT LOW BACK PAINNeena K. Sharma, Janice K. Loudon, Jordan Umscheid, Caleb Laird, Nathan Vogel, Anne Schwartz, Jessie HuisingaPhysical Therapy and Rehab Sciences, University of Kansas Medical Center, Kansas City, Kansas; Physical Therapy Department, Rockhurst University, Kansas City, MissouriPURPOSE/HYPOTHESIS: Low back pain (LBP) can be a potentially devas-tating injury preventing runners from continuously training. There is a need for a greater understanding of trunk and pelvic kinematics during running in healthy people and those with LBP. The purpose of this pi-lot study was to analyze and compare the pelvic and spinal kinematics in healthy runners and runners with a history of LBP. We hypothesized that

CASE DESCRIPTION: A 65-year-old man 5 weeks after a cervical extensor resection and realignment for chronic neck pain. Past surgical history: greater than 30 orthopaedic surgeries of multiple body regions, multiple cervical fusions and revisions due to infection (most recent: 2 years pri-or to evaluation, posterior cervical fusion C2-T2), multilevel lumbar fu-sions with multiple revisions, and 2 rotator cuff repairs on each shoulder (none within the last 10 years). Postoperative restrictions from his most recent procedure included no lifting greater than 10 lb. Chief complaint cervical and upper trapezius pain (best, current, worst: 5/10, 3/10, 8/10) (same as before surgery), as well as difficulty with any form of reaching or lifting overhead which increases symptoms. Data: Limited cervical ROM, diminished function (Neck Disability Index [NDI], 65%; DASH, 61.6%; FABQ-PA, 17/24; Patient-Specific Functional Scale [PSFS], average, 4.66 [driving, sitting, standing]; 6-minute walk test, 1605 ft; UE weakness [glenohumeral HHD], flexion R, 21.2 lb; L, 15.4 lb; abduction R, 19.0 lb; L, 11.9 lb; ER R, 28.7°; L, 19.0°; IR R, 27.9°; L, 16.5°; scapular MMT rhomboids: 3/5 B, middle trapezius 3/5 B, lower trapezius 3/5 B); restric-tions in shoulder ROM (AROM flexion R, 135° pain L, 130°; pain abduc-tion R, 120°; pain L, 125° pain PROM ER R, 70°; L, 63° pain); restric-tions in shoulder mobility (bilateral hypo inferior/posterior). MD referred the patient to physical therapy for scar mobilization, ultrasound and mo-dalities only received clearance after 7 visits and added: shoulder mobi-lizations, AAROM, Thera-Band and dumbbell strengthening for 6 vis-its (10 weeks). Patient educated on a walking program to address deficits noted in 6-minute walk test.OUTCOMES: At discharge (13 visits, 14 weeks total) pain free reaching over-head and diminished pain at baseline (best, current, worst, 0/10, 0/10, 3/10). Improved function (NDI, 46% ± 15.6%), DASH, 30.8% ± 30.8%, PSFS (8.33 ± 3.67), FABQ-PA (8 ± 9/24), 6-minute walk test (1850 ± 245 ft); improved UE strength (shoulder HHD flexion R, 35.3%; L, 81.8%) abduction (R, 27.8%; L, 100.8%); ER (R ,no improvement; L, 53.1%); IR (20.7%; L, 102.4%); scapular MMT rhomboids (4/5); middle trape-zius (4/5 B); lower trapezius (3+/5 B); improved shoulder ROM (AROM) from baseline (flexion R/L, 35°-40°); abduction (R, 20°; L, 43°); PROM (from baseline) (ER R, 6°; L,32°).DISCUSSION: An impairment based approach identified potential contrib-utors to symptoms previously nonresponsive to surgical interventions. Comprehensive examination and treatment of impairments should be considered even in long standing conditions. Improvements in function-al mobility, shoulder ROM and strength resulted in resolution of cervical pain and increased function.REFERENCES: Abbott JH, Schmitt J. Minimum important differences for the patient-specific functional scale, 4 region-specific outcome mea-sures, and the numeric pain rating scale. J Orthop Sports Phys Ther. 2014;44:560-564. Horn K, Jennings S, Richardson G, Vliet D, Hefford C, Abbott J. The Patient-Specific Functional Scale: psychometrics, clinimet-rics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012; 42:30-42. Miller J, Gross A, D’Sylva J, Burnie S, Goldsmith C, Graham N, Haines T, Brönfort G, Hoving J. Manual therapy and ex-ercise for neck pain: a systematic review. Man Ther. 2010;15:334-354. Mintken PE, Cleland JA, Carpenter KJ, Bieniek ML, Keirns M, Whitman JM. Some factors predict successful short-term outcomes in individu-als with shoulder pain receiving cervicothoracic manipulation: a sin-gle-arm trial. Phys Ther. 2010;90:26-42. Petersen S, Domino N, Cook C, Domino N, Cook C. Scapulothoracic muscle strength in individuals with neck pain. J Back Musculoskelet Rehabil. In press. Sueki D, Cleland J, Wainner R. A regional interdependence model of musculoskeletal dys-function: research, mechanisms, and clinical implications. J Man Manip Ther. 2013;21:90-102.

OPO204RELIABILITY OF ULTRASOUND MEASUREMENTS OF ROTATOR CUFF MUSCLE CROSS-SECTIONAL AREA IN HEALTHY ADULTSKshamata M. Shah, Matthew Brennan, Joseph Bucantis,


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= .04), and SA (mean difference, 86.1 milliseconds; P = .01). The humer-al angle of scapular muscle onset was higher for the SA in the SPS group as compared to the control group (15.9° for SPS group, 9.2° for control group; P = .03). Higher humeral angle of muscle onset were observed for MT and LT in the SPS group: MT (14° for SPS group, 6° for control group); LT (18.7° for SPS group, 10.9° for control group), but these differ-ences were not significantly different between groups. There were no sig-nificant differences for the UT.CONCLUSIONS: Onset activation of MT, LT and SA relative to the deltoid were delayed in individuals with SPS, but only a higher humeral angle of muscle onset was found for the SA. These findings support the theory that altered MT, LT and SA activation onsets may account for altered scapular motor control in individuals with SPS. Future research is needed to de-termine if therapeutic exercises can restore relative onset imbalances in scapular muscles, and thus improve pain and disability in those with SPS.CLINICAL RELEVANCE: The MT, LT and SA scapular muscles are slower to activate during arm elevation in individuals with SPS. Exercises aimed at correcting the activation onset of the MT, LT and SA muscles relative to the deltoid muscle may prove beneficial to reduce shoulder pain and dis-ability in individuals with SPS.

OPO207FLEXOR HALLUCIS LONGUS ACTIVATION IN A DANCER’S MODIFIED HEEL RAISE: PRELIMINARY RESULTSHai-Jung Shih, K. Michael Rowley, Kornelia KuligDivision of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CaliforniaPURPOSE/HYPOTHESIS: Flexor hallucis longus (FHL) tendinopathy is high-ly prevalent in female ballet dancers and is related to overuse. A “mod-ified heel raise,” where the foot is placed on the edge of a block so that the toes are unsupported, was introduced as a potential intervention to reduce demand on the FHL. It was reported in our previous study that healthy dancers were able to perform fewer repetitions than nondanc-ers during the modified heel raise fatigue task. However, no electromyo-graphic comparisons have been made between traditional and modified heel raises. Therefore, the aim of this study was to compare muscle acti-vation of the FHL along with the other larger, superficial plantarflexors during traditional and modified heel raises in a healthy dancer. Our hy-pothesis was that muscle activation of the FHL will be lower in the modi-fied heel raise condition.NUMBER OF SUBJECTS: One.MATERIALS/METHODS: One healthy female dancer was instrumented with fine-wire electromyography (EMG) of the FHL, soleus, and lateral gas-trocnemius and performed traditional and modified heel raises at a rate of 30 bpm. The peak FHL activation was identified in the rectified EMG signals, and the activation ratio between FHL and lateral gastrocnemius and soleus was computed using integrated EMG data. Between-repetition variability of the EMG signals was visually analyzed.RESULTS: Analysis revealed higher peak FHL activation, greater FHL/lateral gastrocnemius activation ratio, and greater FHL/soleus activa-tion ratio in the modified heel raise condition. The FHL had greater be-tween-repetition variability during modified heel raise, while the lateral gastrocnemius and soleus had greater variability during traditional heel raise. Kinematic data showed greater toe extension during heel contact in the modified heel raise, which suggested toe extensor cocontraction.CONCLUSIONS: These findings are contrary to our hypothesis, suggesting that the modified heel raise leads to greater FHL activation compared to traditional heel raise in 1 healthy dancer, but visual inspection of be-tween-repetition EMG variability may tell a contradicting story. Future research will include toe extensors activation and EMG variability as out-come measures, and include healthy nondancers as well as dancers with FHL tendinopathy as target populations.CLINICAL RELEVANCE: This research is a part of an ongoing funded study that aims to investigate a novel intervention for FHL tendinopathy. The

(1) healthy long-distance runners will display a consistent kinematic pat-tern of the trunk during running and (2) long-distance runners with a history of LBP will display varied pelvic and spinal kinematics compared to healthy controls.NUMBER OF SUBJECTS: Ten long-distance runners (8 healthy and 2 with a history of LBP).MATERIALS/METHODS: Runners between the ages of 20 and 40 years and who run at least 20 km (approximately 12 mi) a week were eligible. Subjects were excluded if they had current LBP, a neurological impair-ment, a severe structural back deformity, history of back or lower extremi-ty surgery, were pregnant, or answered “yes” on the PAR-Q questionnaire. Motion capture biomarkers were placed on standard bony landmarks of trunk and pelvic to record 3-D joint range of motion during standing and during a 5-minute run on a treadmill. A Matlab software program was used to analyze joint angles.RESULTS: Based on observation, healthy runners have a consistent pattern of trunk and hip kinematics during the running trial. Initial data analysis of trunk and pelvic ROM shows no clinical differences between healthy sub-jects and those with a history of LBP, although subjects with history of LBP have greater anterior pelvic tilt motion (healthy, 13.3 ± 1.6; LBP, 17.2 ± 7.6). More data collection on participants with a history of LBP is underway.CONCLUSIONS: This pilot project has identified trunk and pelvic motion during running between a cohort of healthy runners and 2 runners with a history of LBP. Observational data revealed that the healthy runners dis-play a consistent kinematic pattern in their trunk and pelvis compared to an inconsistent pattern displayed by the runners with a history of LBP.CLINICAL RELEVANCE: Our findings may contribute to the understanding of the causes of LBP in runners and to the development of rehabilitation programs for runners with a history of LBP.

OPO206SCAPULAR MUSCLE ONSET ACTIVATION DURING ARM ELEVATION IN INDIVIDUALS WITH SUBACROMIAL PAIN SYNDROMESapna Sharma, Mark Timmons, Lori A. MichenerDivision of Biokinesiology, University of Southern California, Los Angeles, California; School of Kinesiology, Marshall University, Huntington, West VirginiaPURPOSE/HYPOTHESIS: Subacromial pain syndrome (SPS) is associated with alterations in the scapular muscle amplitude of activity of the trapezius and serratus anterior muscles. However, little is known about the timing of the activation of the scapular muscles. Characterizing scapular muscle onset during functional tasks can provide important information about deficits in motor control strategies in individuals with SPS. The purpose of this study is to characterize the scapular muscle onset activation dur-ing a functional arm task of scaption.NUMBER OF SUBJECTS: Patients with SPS (n = 28; mean age, 38.4 years; 11 female) and age, sex, and dominant arm matched control group (n = 28; mean age, 37.9 years; 11 female).MATERIALS/METHODS: Participants in the SPS and control groups per-formed 5 repetitions of active arm elevation in the scapular plane. Three-dimensional electromagnetic tracking sensors affixed to the humerus, scapula, and thoracic spine were used to record the humeral motion rela-tive to the thoracic spine. Surface electromyography (EMG) was used to record the activation onsets for the deltoid, upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) muscles. Onset was defined as the time value at which the EMG signal exceeded the mean baseline activity by 2 or more standard deviations. Relative ac-tivation muscle onsets of scapular muscles relative to the deltoid, and the humeral angle of onset were compared between groups.RESULTS: Mann-Whitney U tests indicated significant differences in the relative activation onsets for MT, LT, and SA muscles between groups. Specifically, as compared to the control group, the SPS group showed significantly delayed relative activation onsets for MT (mean difference, 101.8 milliseconds; P = .03), LT (mean difference, 102.6 milliseconds; P


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Elizabeth SinishOrthoSports Physical Therapy, Phoenix, ArizonaBACKGROUND AND PURPOSE: The purpose of this case report is to describe the importance of evaluating scapular mechanics in a patient following sternal precautions prior to instructing him in upper extremity strength-ening exercises.CASE DESCRIPTION: The patient was a right hand dominant 72-year-old man who presented with right shoulder pain. He underwent open heart surgery 5 months prior to the evaluation. Pain began approximately 3 months prior to the evaluation while doing UE resisted exercises at cardi-ac rehab. He went to a gym regularly after he finished rehab and reported that he continued the exercises he was taught at rehab. Due to continued shoulder pain, he decided to seek outpatient treatment. Pain was inter-mittent, rated 8/10 at highest and he described it as sharp. Pain location was lateral shoulder and upper arm as well as anterior shoulder. He de-nied numbness and tingling in his right upper extremity. The patient re-ported pain with reaching overhead, lifting 10 lb and reaching back to put on a jacket. During evaluation of this patient’s shoulder motion, the movement faults of excessive scapular internal rotation and insufficient scapular elevation and upward rotation were identified with active shoul-der flexion and abduction, contributing to impingement. When manu-al assistance was given to elevate and upwardly rotate his scapula, pain decreased and ROM improved [1]. However, full passive correction was limited by stiffness in the scapulothoracic muscles. He also demonstrat-ed excessive anterior tilting of the scapula due to shortness and stiffness in the pectorals after limiting his shoulder ROM due to precautions fol-lowing surgery. The patient was given the Diagnosis of Scapular Internal Rotation with Anterior Tilt and Insufficient Upward Rotation Syndrome. Treatment included manual therapy to decrease stiffness in the pectorals [2] and scapulothoracic muscles and then exercises focused of correction of the scapular movement faults. He was educated in the importance of proper scapular alignment and mechanics with all exercises and activities [3] in order to correct his fault movement patterns and decrease stress on the painful tissues [4].OUTCOMES: The patient came in for 6 appointments over 4 weeks. DASH improved from 30 at the initial evaluation to 0 at time of discharge. Scapular elevation and upward rotation improved, enabling him to reach back to don jackets, reach overhead, return to a gym routine and perform all of his activities without pain.DISCUSSION: Many patients have sternal precautions for up to 12 weeks following heart surgery, leading to muscle stiffness and impaired scapu-lar mechanics. In this case, the stiffness contributed to insufficient scapu-lar upward rotation of the scapula, which is found in many patients with impingement [5] and also contributed to excessive anterior tilting of the scapula. If the patient’s scapular mechanics had been evaluated to identi-fy movement faults prior to giving him an upper extremity strengthening program, his shoulder pain may have been prevented.REFERENCES: 1. Seitz AL, McClure PW, Finucane S, Ketchum JM, Walsworth MK, Boardman ND, 3rd, Michener LA. The scapular assis-tance test results in changes in scapular position and subacromial space but not rotator cuff strength in subacromial impingement. J Orthop Sports Phys Ther. 2012;42:400-412. 2. Muraki T, Aoki M, Izumi T, Fujii M, Hidaka E, Miyamoto S. Lengthening of the pectoralis minor mus-cle during passive shoulder motions and stretching techniques: a cadav-eric biomechanical study. Phys Ther. 2009;89:333-341. 3. De Mey K, Danneels LA, Cagnie B, Huyghe L, Seyns E, Cools AM.2013. Conscious correction of scapular orientation in overhead athletes performing select-ed shoulder rehabilitation exercises: the effect on trapezius muscle ac-tivation measured by surface electromyography.” J Orthop Sports Phys Ther. 2013;43:3-10. 4. Sahrmann S, et al. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St Louis, MO: Mosby; 2011. 5. Lawrence RL, Braman JP, LaPrade RF, Ludewig PM. Comparison of 3-dimensional shoulder complex kinematics in in-dividuals with and without shoulder pain, part 1: sternoclavicular, ac-

modified heel raise is currently being reviewed as 1 potential prevention or nonsurgical intervention strategy that could benefit populations at risk of, or suffering from, FHL tendinopathy.

OPO208SCAPULAR AND CERVICAL NEUROMUSCULAR CONTROL DEFICITS IN MUSICIANS WITH PROLONGED UPPER-QUARTER PAIN: A CASE-CONTROL STUDYFlavio Silva, Jean-Michel Brismee, Phillip S. Sizer, Troy Hooper, Gary E. Robinson, Alex B. DiamondOrthopedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TexasPURPOSE/HYPOTHESIS: More than 50% of musicians will develop upper ex-tremity injuries and pain related to instrument use, which can negatively affect or even interrupt their careers. Efficient cervical spine and shoul-der girdle neuromuscular control is essential for upper-quarter musculo-skeletal injury prevention and deficits are linked to a higher prevalence of upper extremity occupational injuries. The purposes of this research were to investigate if there were differences between musicians with and with-out upper quarter prolonged playing related musculoskeletal disorders (PRMSDs) in the presence of: (1) scapular dyskinesis; (2) cervical neu-romuscular control and endurance deficits; and (3) prior injury, playing patterns, and physical fitness habits.NUMBER OF SUBJECTS: Eighty-one subjects consecutively recruited includ-ing student and professional musicians in Tennessee.MATERIALS/METHODS: Seventy-two musicians (24 male, 48 female) were matched based on sex, type of instrument played (string or other) and average hours played per week and assigned to 1 of 2 groups: (1) a symp-tomatic group (mean ± SD age, 23.3 ± 8.2 years) with history of prolonged PRMSDs (symptoms lasting more than 1 week) during the past year; and (2) a control group (mean ± SD age, 25 ± 10.5 years) with no history of PRMSDs lasting more than 1 week. Both groups completed a comprehen-sive demographic questionnaire that included playing patterns, as well as general health related questions and fitness activities exposures. Subjects underwent clinical testing for the presence of scapular dyskinesis and cer-vical neuromuscular control and endurance deficits using the following tests: (1) deep neck flexor endurance test; (2) scapular dyskinesis test; and (3) craniocervical flexion test. Blinding of the assessor as to group as-signment was ensured.RESULTS: Symptomatic subjects presented with statistically significant higher prevalence of positive scapular dyskinesis (26/36 or 72.2% versus 9/36 or 25%; P<.0001) and lower scores for the craniocervical flexion test (mean ± SD, 26.2 ± 2.3 versus 28.4 ± 1.7 seconds; P<.0001). Deep neck flexor endurance, physical activity habits, prior history of PRMSDs and frequency/length of breaks while playing their instrument did not differ significantly between groups.CONCLUSIONS: Musicians with prolonged upper-quarter PRMSDs present-ed with higher prevalence of scapular and cervical neuromuscular con-trol deficits when compared to musicians with no history of prolonged PRMSDs. Addressing these deficits may help in the recovery and preven-tion of PRMSDs.CLINICAL RELEVANCE: Musicians have a very high rate of occupational inju-ries frequently affecting their ability to play their instrument. Our study shows that musicians with prolonged PRMSDs in the upper quarter have higher prevalence of scapular and cervical neuromuscular control defi-cits possibly contributing to their symptoms than musicians without PRMSDs. These findings provide insight and may assist with future stud-ies evaluating programs geared at preventing and managing prolonged PRMSDs in musicians.

OPO209IMPORTANCE OF EVALUATING SCAPULAR MECHANICS IN PATIENTS FOLLOWING STERNAL PRECAUTIONS


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and digital inclinometers, among others. The iPhone is a commonly used smartphone with many applications (apps) available for potential use in measuring joint angles and ROM. If found to be reliable and valid, the iPhone could be an alternate and possibly more assessable tool to use for goniometry. Several apps have been found reliable in measuring motion in the sagittal and coronal planes, but none to date have been found reli-able in the transverse plane. The purpose of this study was to test the reli-ability and validity of the iPhone 6s IOS compass application compared to the gold standard goniometer for measurements in the transverse plane. We hypothesize that the iPhone 6s IOS compass application will not be as valid as the goniometer for transverse plane measurements.NUMBER OF SUBJECTS: Thirty.MATERIALS/METHODS: Four Doctorate of Physical Therapy students acted as raters to measure the 30 randomly selected angles generated by using a protractor widget in whiteboard software which were then verified via “gold standard” steel protractor. The raters measured the 30 angles us-ing an iPhone 6s IOS compass software application. Measurements were taken by each rater 3 times for each angle using different rooms and posi-tions. We calculated the absolute value (AV) of the difference between the actual and measured angles and across repetitions.RESULTS: Across all raters, the mean AV of the difference between the first and second measures ranged from 22.1 to 45.6 (all, P<.05). The differ-ence between the actual angle and both first and second measures var-ied widely across all raters. Example: rater 1, measure 1 = 0.7 (P = .001); measure 2 = 38.2 (P<.0001). The mean AV of the difference between ac-tual angle and measured angle varied from 0.7 to 44.1. The difference was greater for the first measure for some raters and greater for the second measure for others.CONCLUSIONS: The “Compass” software application for this smartphone was found to be unreliable and subsequently invalid in measuring fixed angles in the transverse plane due to the instruments inability to main-tain a stable true north.CLINICAL RELEVANCE: The results of this study indicate that the specific soft-ware and device tested should not be used for clinical goniometry.

OPO212ACHILLES TENDINOPATHY OCCURS ACROSS THE AGE SPAN AND AFFECTS QUALITY OF LIFEAndrew L. Sprague, Laura Pontiggia, Daniel H. Cortes, Karin G. SilbernagelDepartment of Physical Therapy, University of Delaware, Newark, Delaware; Statistics, University of the Sciences, Philadelphia, Pennsylvania; Mechanical and Nuclear Engineering, Pennsylvania State University, University Park, PennsylvaniaPURPOSE/HYPOTHESIS: Achilles tendinopathy is often described as a sports injury occurring mainly in runners; however, 1 recent Dutch study report-ed that only 35% of the patients with Achilles tendinopathy seeking help from a general practitioner were sports related [1]. Given the large num-ber of nonathletes with Achilles tendinopathy, there is a need to better understand the condition’s health impacts in a general population. The purpose of this study was to examine individual and injury-specific fac-tors, along with health-related outcomes in patients with Achilles tendi-nopathy [2].NUMBER OF SUBJECTS: All subjects (n = 53, 29 male) included in a larger prospective study on Achilles tendinopathy between November 13, 2014 and April 6, 2016 were included.MATERIALS/METHODS: Subjects completed questionnaires regarding their past medical history, current Achilles tendon injury and physical activ-ity level. Outcome measures used were the Victorian Institute of Sport Assessment-Achilles (VISA-A), the Foot and Ankle Outcome Score-Quality of Life subscale (FAOS-QOL), the Pain Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) [3-7]. Lower extrem-ity function was assessed using the single-leg heel rise test.RESULTS: The mean ± SD (range) age was 48 ± 16 years (19-79 years). Age

romioclavicular, and scapulothoracic Joints. J Orthop Sports Phys Ther. 2014;44:636-645.

OPO210TIMED UP AND GO IS MOST PREDICTIVE OF PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM SCORE IN INDIVIDUALS AWAITING TOTAL KNEE ARTHROPLASTYKaitlyn Sly, Scott Eskildsen, Richard A. Faldowski, Christopher W. Olcott, Daniel J. Del Gaizo, Deborah L. GivensDivision of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North CarolinaPURPOSE/HYPOTHESIS: The Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing (CAT) physical function domain has the potential to quickly assess self-report-ed function before and after total knee arthroplasty (TKA). The timed up and go (TUG) test is commonly used in clinical practice but adminis-tration may be hindered due to space and patient limitations. PROMIS CAT has the potential to address these limitations but we lack evidence if TUG as well as other health indicators are predictors of PROMIS CAT. The purpose was to assess whether TUG, body mass index (BMI), numer-ic pain-rating scale (NPRS), and smoking status are predictors of phys-ical function, as measured by the PROMIS CAT, in candidates for TKA surgery.NUMBER OF SUBJECTS: Sixty-five (40 female; mean ± SD age, 62.6 ± 8.9 years; height, 167.7 ± 9.4 cm; weight, 91.7 ± 17.0 kg).MATERIALS/METHODS: Participants presenting to the University Orthopaedic Clinic with a diagnosis of severe knee osteoarthritis (OA) were offered the option of TKA by an orthopaedic surgeon. The PROMIS CAT physical function domain score, TUG, NPRS, BMI, and smoking sta-tus were collected on enrollment in the clinical trial. Multiple linear re-gression analyses were performed to determine the strongest predictors of PROMIS CAT (P<.05).RESULTS: Smoking status did not affect the relationship between any of the variables and PROMIS CAT. The multiple regression analyses indi-cated that the TUG test was the best predictor of PROMIS score. BMI and NPRS did not incrementally help predict the PROMIS score beyond the TUG test. PROMIS CAT physical function domain scores had a mod-erate, negative correlation with the TUG test (r = –0.43; 95% CI: –0.61, –0.19; P≤.0001) and a weak, negative correlation with NPRS (r = –0.30; 95% CI: –0.51, –0.05; P≤.0102).CONCLUSIONS: The relationship between PROMIS CAT physical function and the TUG test suggests that the PROMIS is not a surrogate for this functional performance measure in candidates for TKA. However, the TUG test was the best predictor of PROMIS physical function score com-pared to BMI, NPRS, and smoking status.CLINICAL RELEVANCE: Clinicians should consider utilizing a variety of self-report and functional outcome measures to adequately assess patients with severe knee OA who are candidates for TKA surgery.

OPO211RELIABILITY AND VALIDITY OF A SMARTPHONE WITH COMPASS APP FOR MEASURING TRANSVERSE PLANE MOTIONBryon A. Smith, Shawn Hunt, Philip Grattan, Kathryn E. Roach, Nina Kelly, Kevin Cochran, Robert B. Smith, Koren LaviPhysical Therapy, University of Miami, Coral Gables, FloridaPURPOSE/HYPOTHESIS: A therapist’s ability to accurately assess a patient’s range of motion (ROM) is a key component of the physical examination. In order for this information to be useful, it is necessary that it is accurate, reliable and valid. There are several tools on the market that can assess joint ROM, including the universal goniometer, electronic goniometers


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formed by calculating absolute and standardized effect sizes of the change scores (postintervention minus the average baseline) for PPT, HPT, and HTS. HPT increased in CON by 2.04°C (95% CI: 1.21°C, 2.86°C; η2 = 1.09), ECC by 1.39°C (95% CI: 0.60°C, 2.19°C; η2 = 0.79), and ISOM by 2.45°C (95% CI: 1.39°C, 3.51°C; η2 = 1.17). HTS decreased in CON by 5.09 mm (95% CI: 6.10, –16.27 mm; η2 = –0.28), ECC by 12.50 mm (95% CI: –3.65, –21.35 mm; η2 = –0.9), and ISOM by 7.39 mm (95% CI: –2.22, –12.56 mm; η2 = –0.33). There was no consistent change in PPT across groups. Data collection will continue to include 10 females and males in each treatment group as per prior sample-size estimate.CONCLUSIONS: Preliminary analysis showed that after 1 week of exercise, all treatment groups similarly reduced pain sensitivity for HPT, and ISOM and ECC groups also reduced HTS consistently. The changes observed in pain sensitivity support the use of long (5 seconds) duration contractions to create hypoalgesia and de-emphasize contraction type.CLINICAL RELEVANCE: Contraction duration, not contraction type, may be an important variable that imparts hypoalgesic effects of exercise.

OPO214TRIGGER POINT DRY NEEDLING QUALITY CONTROL MEASURES AT BAYLOR REHABILITATIONMichelle R. Steinhagen, Laurel DuPontDoctor of Physical Therapy Program, Baylor Institute for Rehabilitation-Outpatient Services, Dallas, TexasPURPOSE: To provide standardized quality control methods to ensure ex-cellent and safe outcomes for clinicians and patients in Trigger Point Dry Needling (TPDN) procedures in a outpatient rehab setting.DESCRIPTION: An experienced core group of clinicians (n = 3) regularly meet to ensure current clinical treatment parameters and outcomes by developing and performing competency standards and check-offs prior to initiation of TPDN during patient care. Yearly competency checks are required to ensure compliance to company policies, procedures and safety as well as clinical reasoning for the use of TPDN. Baseline requirements for TPDN clinicians included completion of a certified continuing edu-cation course approved by the Texas State Board, received competency checks by 1 of 3 core clinicians for standardized methodology, and yearly competency checks through practical and written exam. In 2013, due to the growth to 20 clinicians performing TPDN from 5 in 2010, an inter-nally developed mandatory refresher class, with CEU approval, was held to review technique, clinical reasoning, safety and adherence to policies. As the number of clinicians exponentially increased from 5 to 88 by the year 2015, we expanded the quality measures by standardizing compe-tencies through baseline written testing to maintain the integrity of the policies as well as clinical reasoning. In late 2015, an email-based blog platform for all needlers was initiated to stimulate discussion, answer questions and provide current concepts in dry needling.SUMMARY OF USE: Patients expect safety and quality from each interac-tion with a health care professional. As our Trigger Point Dry Needling (TPDN) program expanded at Baylor Rehab from 5 clinicians to 88 over a 6-year span, we were able to demonstrate the ability to maintain the quality control measures and ensure safety, adherence to policy and stan-dardization. In 2015 alone, we estimate that out of 354 295 patient visits, approximately 11% of patients seen in the clinic were needled with TPDN techniques. Of the approximate 38 972 needling encounters in 2015, there were zero reported adverse patient incidents. In summary, over 6 years and countless encounters, we were able to maintain zero adverse patient incidents.IMPORTANCE TO MEMBERS: Due to the expansion of dry needling in the phys-ical therapy profession in the past 4 to 5 years, there are some increasing concerns among other health care providers of the safety and qualifica-tions for a licensed physical therapist to perform this invasive procedure. In order to maintain a level of quality control, our organization has ad-opted a proactive approach of quality measures and controls to maintain consistency and safety.

ranges were uniformly distributed (P>.25) and there was no evidence of age dependency. The median (IQR) symptom duration was 10 (4-17) months. Past medical history of interest was that 23 (20 on same side as current injury) out of 52 participants reported a prior ankle injury. The mean ± SD score for the VISA-A was 57 ± 21 and for the FAOS-QOL was 49 ± 20. Thirty-three out of 51 patients (65%) reported decreased physi-cal activity level due to their Achilles tendon symptoms. There were sig-nificant differences in heel rise performance for height (P<.0001), rep-etitions (P = .0008), and total work (P = .0002) between injured and uninjured side. There were significant correlations (r = 0.576, P<.0001) between VISA-A score and participants change in activity level following their Achilles tendon injury. VISA-A scores did not correlate significant-ly with FAOS-QOL, TSK, or PCS scores (P = .09-.99). There were signif-icant correlations between FAOS-QOL and PCS (r = –0.436, P = .0039) and TSK (r = –0.578, P = .0002). Heel rise test performance did not cor-relate with TSK or PCS scores (P = .12-.92).CONCLUSIONS: Achilles tendinopathy affects patients across the life-span and a history of ankle injuries is common. These patients have significant symptoms, impaired foot and ankle related quality of life and reduced physical activity. The FAOS-QOL did not correlate with VISA-A but did correlate with PCS and TSK. This indicates that patient’s beliefs about pain and movement may have a larger impact on their foot and ankle re-lated quality of life than symptom severity.CLINICAL RELEVANCE: Clinicians should be aware that Achilles tendinopa-thy may occur in any age group and that prior ankle injuries are common. Additionally, clinicians may need to address kinesiophobia or pain cata-strophizing beliefs to achieve optimal patient outcomes.

OPO213THE EFFECTS OF ECCENTRIC, CONCENTRIC, AND ISOMETRIC CONTRACTIONS ON PAIN SENSITIVITY OVER THE ACHILLES TENDONScott K. Stackhouse, Brian J. Eckenrode, Kaitlyn Colagreco, Elizabeth Michel, Josh TizzardDepartment of Physical Therapy, Arcadia University, Glenside, PennsylvaniaPURPOSE/HYPOTHESIS: There is mixed evidence on the superiority of eccen-tric-only exercise in reducing pain in chronic tendinopathies. The pur-pose of this study was to investigate the effects of plantarflexion exercise (eccentric, concentric, or isometric) on pain sensitivity measures over the Achilles tendon. We hypothesized that there will be no between-group differences in the effects on pain sensitivity when contraction duration is equivalent across groups.NUMBER OF SUBJECTS: Sixty-nine adults were screened and 42 were found eligible (mean ± SD age, 24.6 ± 2.8 years) and block-randomized by sex into eccentric (ECC), concentric (CON), or isometric (ISOM) groups.MATERIALS/METHODS: After eligibility screening and consent, subjects com-pleted a series of questionnaires on pain and anxiety. Participants had their dominant side Achilles tendon assessed for pressure pain threshold (PPT) with a digital algometer, and heat pain threshold (HPT) and heat temporal summation (HTS) assessed with a computer-controlled ther-mode at 2 cm proximal to calcaneal insertion. The study timeline was as follows: Baseline 1, 48-hour washout, Baseline 2, 1-week intervention, and next day Postintervention assessment. After the Baseline 2 assess-ment, participants were instructed in specific exercise according to group assignment: CON, ECC, or ISOM plantarflexion contractions. One in-vestigator observed and gave feedback during their first 3 sets of 15 rep-etitions of exercise. All contraction durations were to last 5 seconds and subjects were asked to complete 3 sets of 15 repetitions 2 times a day for 7 days.RESULTS: There were no differences between groups on pain and anxiety questionnaires and for exercise compliance (P>.05). Excluded partici-pants were mostly male due to not meeting a HPT of less than or equal to 46.5°C. Sex breakdown per group was: CON, 8 female, 6 male; ECC, 8 female, 5 male; ISOM, 8 female, 6 male. Preliminary analysis was per-


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The purpose of this pilot study was to examine the effects of a weight bearing Windlass Test (WBWT) on midfoot mobility using the dorsal arch height (DAH) measure in pathological and healthy feet.NUMBER OF SUBJECTS: Sixteen subjects (mean age, 32.2 years; BMI, 24.3 kg/m2; 81% female) with a history of unilateral foot/ankle pathology con-sented to participate in the study. Foot and ankle pathology included a range of pathologies and chronicity, including foot fractures, heel pain, ankle sprain, and plantar fasciitis.MATERIALS/METHODS: Subjects were placed in a standardized bilateral stance position. A digital gauge (Mitutoyo Corporation, Japan) placed at 50% of the total foot length was used by a blinded examiner to measure DAH (mm) in resting stance position and during the WBWT. Three mea-sures were recorded for each foot. Intertrial reliability across 3 trials was assessed with intraclass correlation coefficients (ICC model 3,1). Paired t tests, applied to the mean of 3 trials, were used to examine group differ-ences in DAH change between healthy and pathological feet.RESULTS: Intertrial reliability was good (ICC = 0.79). DAH change was not significantly different between healthy feet and pathologic feet (mean ± SD healthy, 4.4 ± 1.2 mm versus pathologic, 4.3 ± 2.3 mm; P = .89). The range of DAH change scores across both feet was 1.6 to 9.6 mm.CONCLUSIONS: The DAH during the WBWT demonstrated excellent in-tertrial reliability. The range of midfoot motion during the WBWT was smaller than ranges reported in the literature for the Navicular Drop Test. No difference in DAH during the WBWT between groups was found, but may be explained by study limitations.CLINICAL RELEVANCE: Midfoot mobility during the WBWT is small and may not reflect overall midfoot motion, but may reflect the specific function of the plantar fascia. Future research is needed to determine the utility of the WBWT in examining plantar fascia function.

OPO217A COMPARISON OF INTRINSIC FOOT STRENGTH IN PATHOLOGICAL AND HEALTHY FEET: A PILOT STUDYKaren Stevens, Jessica Nilles, Nicholas Martin, Troy McGilligan, Erin Rucinski, Ryan Breen, Kahlin ShandleyRosalind Franklin University, Libertyville, IllinoisPURPOSE/HYPOTHESIS: Intrinsic foot muscle weakness has been implicated in a range of foot deformities and disorders. However, an objective mea-sure of the relationship between muscle weakness and foot pathology has not been established. The purpose of the present study was to compare in-trinsic foot strength between pathological and healthy feet using a Foot-Strength Test Device (US Patent Application number 15/689,550).NUMBER OF SUBJECTS: Sixteen subjects (mean age, 32.2 years; 81% female) with a history of unilateral foot/ankle pathology consented to participate in the study. Reported pathology included: fracture (3), ankle sprain (5), tendinopathy/tendonitis (3), plantar fasciitis (3), and other (2).MATERIALS/METHODS: Subjects were randomly assigned to side and posi-tion (seated or standing) testing order. Foot strength was measured with a Foot-Strength Test Device (US Patent Application number 15/689,550). After completing 3 practice trials, subjects pulled on a towel attached to a dynamometer by curling their toes. Peak force (lb) was recorded. Three trials were performed on each foot in both standing and seated positions, and the mean of the 3 trials used for data analysis. Paired t tests were used to examine group differences in foot intrinsic muscle strength, and for differences in position (sitting versus standing) with a priori alpha level of .05.RESULTS: Mean ± SD strength values were: pathological sitting, 2.03 ± 0.96 lb and standing, 3.28 ± 1.02 lb; healthy sitting, 2.19 ± 1.28 lb and standing, 3.55 ± 1.32 lb. No differences in strength between pathologi-cal and healthy feet in sitting or standing were found. However, a trend of greater strength of the healthy foot was observed. Differences in strength between standing and seated positions were found (P<.05).CONCLUSIONS: No difference in intrinsic foot strength between pathologi-cal and healthy feet was found, but may be explained by study limitations

OPO215RETURN TO OVERHEAD SPORT FOLLOWING ULNAR COLLATERAL LIGAMENT INJURY: A SYSTEMATIC REVIEWTaylor Stern, Jeremy McCullough, Avi Bagley, Derek Poulson, Aaron Rygiel, Evan M. Vasilauskas, Michael ReimanDuke University, Durham, North CarolinaPURPOSE/HYPOTHESIS: Ulnar Collateral Ligament (UCL) injuries are com-mon amongst overhead athletes of all ages. Twenty-five percent of ma-jor league pitchers report a history of UCL reconstruction. Surgical treat-ments for UCL injuries have increased over the past 2 decades. The goal of this systematic review was to examine the RTP rate as well as the return to same level of play or higher (RTSLP) rate of athletes after UCL injuries.NUMBER OF SUBJECTS: Twenty-five studies, subjects followed up/enrolled (2288/3030) (2289 elbows).MATERIALS/METHODS: A computer-assisted search of PubMed, CINAHL, Embase and SportDiscus databases was utilized, searching for articles from 1999 until December 2015. Studies prior to 1999 were not includ-ed due to consensus reporting of significant changes in surgical tech-nique. The search utilized key terminology associated with ulnar col-lateral ligament reconstruction, revision, or repair in overhead athletes. This systematic review was designed based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodological quality of the individual studies was assessed using a modified Downs and Black checklist.RESULTS: The search resulted in 421 abstracts, which was narrowed down to 25 research articles. Downs and Black scores of the articles revealed 2 high quality and 4 moderate quality. The remaining 19 articles rated in the low quality category. Overall RTP rate after UCL injury was 89.7% (range, 42%-100%). The average overall RTSLP rate was 81%. Only 28% of the articles included pitching performance, 86% of these showed sig-nificant decrease in innings pitched, 71% showed an increased trend in ERA, and 57% showed an increase trend in WHIP.CONCLUSIONS: Low quality studies demonstrate a high RTP and RTSLP post UCL injury. Unfortunately, significant variability in reporting of data and a lack of a standardized definition for returning to play after UCL in-jury exists in these studies. Therefore, the actual benefit of UCL surgery is unknown. There also needs to be more high quality studies done to an-alyze the return to sport outcomes in athletes that undergo UCL surgery. The decline in pitching statistics throughout the majority of studies in-cluded in this review highlights the disparity between public perception of UCL surgery and the true potential outcomes for an athlete who dam-ages his or her UCL. There is much variability in reporting of data and a lack of a standardized definition for returning to play after UCL injury. It is clear that future high quality studies are necessary to clearly eluci-date the return to sport outcomes in athletes that undergo UCL surgery.CLINICAL RELEVANCE: This review will serve to inform health care providers, coaches and athletes of the limited quality of studies describing the ex-pected prognosis for RTP among athletes that sustain a UCL injury and undergo subsequent surgery. It will also serve as a stimulus for improved quality of studies and increased emphasis on prevention of these injuries.

OPO216THE EFFECT OF A WEIGHT-BEARING WINDLASS TEST ON DORSAL ARCH HEIGHT IN HEALTHY AND PATHOLOGICAL FEETKaren Stevens, Jessica Nilles, Amber Lisowe, Shelby Heilman, Quinn de la Concepcion, Sean Seiler, Kailee SpringerRosalind Franklin University, Libertyville, IllinoisPURPOSE/HYPOTHESIS: The mobility and support of the medial longitudi-nal arch is important in managing patients with foot and ankle pathology. The windlass function of the plantar fascia provides a mechanism of me-dial arch support and power generation. The Windlass Test has been used in diagnosing plantar fasciitis, but its sensitivity is low. Clinical measures assessing the effect of the plantar fascia on midfoot mobility are lacking.


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Central Michigan University, Mt Pleasant, MichiganPURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the rela-tionship between normalized kinematic and kinetic stability indices for spinal regions during nondominant leg standing with eyes-open and eyes-closed conditions between subjects with recurrent low back pain (LBP) and control subjects.NUMBER OF SUBJECTS: Forty-two subjects participated in the study, includ-ing 22 subjects with LBP (12 male, 10 female) and 20 control subjects (12 male, 8 female).MATERIALS/METHODS: The kinematic stability index for the spinal regions (core spine model, lumbar spine, lower thorax, and upper thorax) and the kinetic stability index (utilizing force plate) were measured. All partici-pants were asked to maintain nondominant leg standing for 25 seconds, with the dominant hip and knee flexed approximately 90°.RESULTS: For the kinematic index for stability, the visual condition (F = 30.06, P = .0001) and spinal region (F = 10.82, P = .002) were statistical-ly significant. The post hoc test results indicated a significant difference in the lumbar spine compared with the upper and lower thorax and the core spine model. The kinetic stability index during the eyes-closed condition significantly decreased in the LBP group (t = –3.24, P = .002).CONCLUSIONS: The subjects with recurrent LBP demonstrated higher lum-bar spine stability in the eyes-open condition. This higher stability of the lumbar spine might be due to a possible pain avoiding strategy from the standing limb. The LBP group also demonstrated significantly decreased kinetic stability during the eyes-closed condition.CLINICAL RELEVANCE: The subjects with recurrent LBP rely on visual input due to decreased proprioception from lumbar spine injuries while min-imizing normalized kinetic changes from the ground. Clinicians need to consider both kinetic and kinematic indices while considering visual con-dition for lumbar spine stability in subjects with recurrent LBP. Funding source: Central Michigan University.

OPO220LUMBAR SPINE STIFFNESS CHANGES AND MUSCLE ACTIVATION DURING THE PRONE INSTABILITY TESTWon Sung, David Ebaugh, Gregory E. Hicks, Scott K. Stackhouse, Sue Smith, Peemongkon Wattananon, Sheri P. SilfiesDrexel University, Philadelphia, Pennsylvania; University of Delaware, Newark, Delaware; Arcadia University, Glenside, Pennsylvania; Mahidol University, Bangkok, ThailandPURPOSE/HYPOTHESIS: Prone instability testing (PIT) is used to identify in-dividuals with low back pain (LBP) that would benefit from trunk stabi-lization exercises. Theoretically, activity from muscles such as the lumbar multifidus (LM) enhances spinal stiffness during leg raising of the PIT, re-sulting in pain reduction. However, this theory lacks evidence. Our pur-poses were: (1) compare and contrast lumbar spine stiffness changes and muscle activation patterns in individuals with and without LPB and (2) determine if preferential contraction of the LM during the PIT via neuro-muscular electrical stimulation (LMES) results in similar pain reduction and stiffness increases as active leg raising.NUMBER OF SUBJECTS: Twenty.MATERIALS/METHODS: Individuals (n = 10) with LBP (5 female; mean ± SD age, 29 ± 6 years) and individuals (n = 10) without LBP (NLBP) (2 female; mean ± SD age, 29 ± 3 years) performed the PIT. Three-dimensional kine-matics measured lumbar spine stiffness (LSS) via a bending beam mod-el. Stiffness changes were compared across PIT positions (prone, start position, leg raise) with a repeated ANOVA, and between groups with a mixed ANOVA, α = .05. Surface EMG electrodes recorded muscle activi-ty of LM, lumbar and thoracic erector spinae (LES, TES), latissimus dorsi (LD), gluteus maximus (GMX) and hamstrings (HS) bilaterally. Muscle activations were normalized to maximal volitional contractions. Principal component analysis (PCA) was used to extract muscle synergies used by individuals with and without LBP during leg raising. Mixed ANOVA com-

of sample size and varied pathology. A trend of greater strength on the healthy side was observed and warrants further research. Position was found to affect foot strength, with greater force production found in a standing versus seated position. Future research examining how position and specific pathology affect foot muscle strength may improve interven-tion planning.CLINICAL RELEVANCE: Understanding how foot and/or ankle pathology af-fects foot muscle strength may lead to improved intervention planning in managing patients. The trend of greater strength of the healthy foot in this pilot study should be further investigated to determine if specific types of pathology are associated with foot weakness. Differences in force production between the seated and standing positions should be consid-ered in exercise prescription for foot intrinsic strengthening.

OPO218ATTITUDES AND PERSPECTIVES ON ANKLE FUNCTION IN PEOPLE WITH HEMOPHILIA: A QUALITATIVE STUDYKate Stribling, Nancy Durben, David Oleson, Michael RechtOregon Health and Science University, Portland, OregonPURPOSE/HYPOTHESIS: For people with hemophilia, mild trauma can cause internal joint bleeding. Over time, repeated bleeding episodes can result in joint stiffness and pain, limited range of motion, and ultimately irre-versible bony changes. Ankles are a frequently affected joint and ankle pain occurs relatively early in life. Impaired ankle function can affect the ability of people with hemophilia to participate in activities of daily living, work and leisure. The purpose of this study was to explore the experiences and priorities of people with hemophilia A or B regarding their foot and ankle function, activity and participation.NUMBER OF SUBJECTS: Eleven.MATERIALS/METHODS: Eleven participants with hemophilia A or B, 21 years and older with a history of ankle pain, were recruited from a sam-ple of convenience from the Pacific Northwestern, USA. Individual and group interviews were conducted using a semi-structured format. The in-terviews were recorded, transcribed and then analyzed using thematic analysis with NVivo 10 Software.RESULTS: Four themes emerged: (1) “Pain impacts my daily life, but I still have to get things done.” Participants reported an expectation of joint pain but were more concerned with how pain affects their ability to par-ticipate in activities they want to do. (2) “Management of ankle function is highly individualized.” Participants reported a wide variety of person-al strategies and techniques including but not limited to orthotics, foot-wear, adaptive equipment, medications and exercise. (3) “Self-advocacy is crucial.” Participants reported self-advocacy skills as necessary in or-der to receive quality care but often expressed frustration that achieve-ment of desired outcomes required this skill. (4) “I want health care pro-viders who listen to me and respect my knowledge.” Participants stated a desire for health care providers to acknowledge and value the patient’s in-put in his plan of care.CONCLUSIONS: For our participants, joint paint and ankle dysfunction af-fect daily life. Expressed themes highlighted priorities for participation, health management and for desired health care. The sample was limited to participants in the Pacific Northwest in the United States and therefore may only be generalized to this demographic.CLINICAL RELEVANCE: As health care moves from volume-based to value-based care delivery, the patient’s voice is increasingly important in prior-itizing the most impactful interventions. The participant-identified pri-orities and experiences from our study can begin to inform health care providers, allowing them to deliver more impactful care, improved rap-port, and more valuable services for their patients with hemophilia.

OPO219A NOVEL INDEX BASED ON KINEMATIC AND KINETIC MEASURES FOR SPINAL STABILITY IN SUBJECTS WITH RECURRENT LOW BACK PAINPaul S. Sung


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ent the 2 modes of lifting are equivalent within the standard 20% percent difference.CLINICAL RELEVANCE: It is challenging to determine an individual’s sincer-ity of effort based on visual observation alone during an FCE. Patients whose efforts are not sincere during physical evaluation may overuse treatment, have prolonged recovery, or increased cost of care. Ongoing research using distraction based lifting with the XRTS Lever Arm for de-termining patient effort during testing is needed in which data collection simulates the clinical environment by testing subjects for both modes of lifting on the same day rather than on 2 separate days. Further, increased scientific evidence to support objective measurement of effort will assist in eliminating clinician bias in determining functional capacity evalua-tion results.

OPO222THE EFFECTS OF DIFFERENT VERBAL INSTRUCTIONS ON HOP HEIGHT AND CONTACT TIME DURING THE VERTICAL HOP TEST IN RECREATIONAL ATHLETES POST–ACL RECONSTRUCTIONJeremiah J. Tate, Betsy A. MyersPhysical Therapy, University of Tennessee at Chattanooga, Chattanooga, TennesseePURPOSE/HYPOTHESIS: The purpose of this study was to assess the effect of 2 verbal instructions on contact time and jump height during perfor-mance of a vertical hop test in recreational athletes post ACL reconstruc-tion. We hypothesized that participants’ contact times would decrease when asked to perform the test as fast as possible and hop height would remain similar. We also hypothesized that no differences would exist be-tween limbs for both contact time and hop height.NUMBER OF SUBJECTS: Twelve college-aged recreational athletes (9 female, 3 male) who had undergone ACL reconstruction surgery were included in this study. Participants were currently active 2 times per week for a mini-mum of 30 minutes and participated in jumping/cutting activities at least 1 time per month.MATERIALS/METHODS: Participants performed a vertical hop test which con-sisted of 5 consecutive hops on the same lower extremity. An optical mea-surement system (Optojump, Micrograte, USA) was used to determine contact time and hop height. Participants were instructed to hop as high as possible on 1 leg. During the landing, participants were instructed to try to land in the same spot. The vertical hop test was then repeated in the same manner, but participants were instructed to perform the test as quickly as possible. Mixed model ANOVAs (instruction by limb) were performed to analyze for potential differences and Tukey’s post hoc test was used for multiple pairwise comparisons.RESULTS: A significant interaction (P = .04) was demonstrated for con-tact time. Contact times were faster when participants were asked to per-form the hops as quickly as possible (1.88 seconds versus 0.57 seconds, P = .005). Additionally, contact time on the involved limb was greater than the uninvolved limb (2.03 seconds versus 1.73 seconds, P = .005). This difference between limbs was not demonstrated when participants were asked to hop as quickly as possible (0.59 seconds versus 0.55 seconds, P = .91). A significant limb effect (P = .009) was demonstrated for hop height indicating that hop height on the involved limb was less than the unin-volved limb for both instructions (13.7 cm versus 14.7 cm and 12.4 cm ver-sus 13.8 cm).CONCLUSIONS: Results indicate that vertical hop test verbal instructions have an effect on contact time and hop height. Participants tended to in-crease contact time on their involved lower extremity in efforts to max-imize hop height when instructions focused primarily on hop height. There were no differences in contact time between limbs when partici-pants were asked to perform the test as quickly as possible. Hop height differences were similar between limbs for both instructions.CLINICAL RELEVANCE: The vertical hop test has the potential to demonstrate asymmetries in hop height regardless of how fast a person performs the test. Instructions that are linked to how quickly a person performs the test

pared percent activation of individual muscles between groups.RESULTS: All participants with LBP had a positive PIT with increases in LSS compared to prone position (P<.001). A significant increase in LSS was also found compared to prone (P = .042) in the NLBP group. LMES resulted in greater LSS compared to prone for both LBP (P = .029) and NLBP (P = .014) groups. PCA revealed 3 muscle synergies that explained 93% of the variance in individuals with NLBP, with 42% of the vari-ance accounted for (VAF) by synergy containing the LM, LES, and LD. Individuals with LBP had only 2 synergies that yielded 77% of the vari-ance, with 57% of the VAF by the synergy containing the TES, LD, and HS. NLBP had significantly greater activation of LM, LES, and GMX compared to those with LBP (P = .03).CONCLUSIONS: LSS increased during the active leg raising portion of the PIT and was reproduced with LMES, supporting the role of LM muscle activity in increasing lumbar stiffness. Despite achieving a positive PIT, individuals with LBP had differences in their muscle activation patterns and reduced LM and LES activation that required different muscle syner-gies to achieve lumbar spine stiffening and a positive test.CLINICAL RELEVANCE: Individuals with LBP demonstrate lumbar spine stiff-ening during the PIT, but may accomplish this using a different strategy compared to NLBP group. This may suggest altered neuromuscular con-trol that responds to a stabilization exercises. The ability to obtain lum-bar spine stiffening with LMES, may suggest its potential adjunctive role in rehabilitation.

OPO221TRADITIONAL CRATE VERSUS XRTS LEVER ARM LIFTMarcie C. Swift, Janice K. Loudon, Brian M. Becker, Garrett Greaves, Megan Reardon, Justin ReinhardPhysical Therapy, Rockhurst University, Kansas City, MissouriPURPOSE/HYPOTHESIS: Within a functional capacity evaluation (FCE), an individual’s sincere maximal effort must be determined. Objective tools or methods such as the traditional crate lift are used to assess sincerity of effort. The XRTS Lever Arm replicates the biomechanics of the crate lift. The purpose of this research study is to (1) compare the maximum lifting capacities on the XRTS Lever Arm with the traditional crate lift and (2) determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift.NUMBER OF SUBJECTS: A total of 41 subjects between ages 20 and 40 with no upper or lower extremity injuries within the past 12 months were re-cruited to participate in this study. Subjects who were able to lift more than 110 lb in the crate lift were excluded.MATERIALS/METHODS: On the first day of testing, investigators established 1RM for each subject performing a lift from 20 inches off the ground to their navel using a traditional crate. Subjects were then randomly as-signed 5 weights ranging from 10% to 100% of their determined 1RM and asked to give a rating of their perceived exertion (RPEs) after each lift. The subjects repeated the same procedure used for the crate lift 2 to 5 days later using the XRTS Lever Arm. For Purpose 1, paired t tests were used to compare maximal lifts between subjects. For Purpose 2, Spearman’s correlation coefficient was used to determine the relationship of perceived exertion between the XRTS Lever Arm and the traditional crate lift. For all statistical testing, alpha was set at less than .05.RESULTS: There was a statistically significant difference (P<.04) between maximal lift values for the 2 lifting modes. The percent difference be-tween the traditional crate lift and the XRTS Lever Arm was 10.5% ± 6.4% with values ranging between 0.82% and 23.78%. Of the 41 subjects, 38 of the subjects were below a 20% difference and 31 subjects were be-low a 15% difference. Additionally, there was a positive correlation be-tween the RPE on the traditional crate lift and the XRTS Lever Arm (P = .92).CONCLUSIONS: This validation study demonstrates that lift effort and per-ceived exertion are not different between lifting modes. Although the ac-tual maximal lift values for the modes of lifting were statistically differ-


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Columbus, OhioPURPOSE/HYPOTHESIS: Knee impairments are common in individuals with articular cartilage defects (ACD) in the patellofemoral (PF) or tibiofemo-ral (TF) compartment of the knee and may induce a protective response to unload the ACD. Yet, it is unknown if individuals with ACDs modify activity to provide compartment-specific unloading. The purpose of this study was to elucidate the compartment-specific loading patterns during gait, quantified as joint reaction forces (JRF), of individuals with knee ACDs compared to healthy controls. We hypothesized that individuals with ACDs would unload the affected compartment during gait.NUMBER OF SUBJECTS: Twenty-seven individuals with ACDs, 19 healthy controls (HC).MATERIALS/METHODS: Individuals with ACDs were divided into groups ac-cording to ACD location: PF (only PF ACD), TF (only TF ACD), and MIX (both PF and TF ACDs). The involved limb was randomly assigned in the HC group. Participants underwent 3-D gait analysis at self-selected speed. TF-JRF was calculated using inverse dynamics. PF-JRF was de-rived from an estimate of quadriceps force and knee flexion angle. The primary variables of interest were first and second peaks for the PF- and TF-JRF (units body weight [BW]), corresponding with each half of stance. Secondary variables included gait speed, quadriceps strength, knee function (Knee Injury and Osteoarthritis Outcomes Score) and ac-tivity level (Tegner Activity Scale). We tested for group differences in peak PF-JRF and TF-JRF with a multivariate analysis of variance. Related sec-ondary variables (correlation analyses, P<.05) were added as covariates in a multivariate analysis of covariance.RESULTS: The first peak PF-JRF and TF-JRF were similar in the TF and MIX groups (0.75-1.0 BW, P = .6-.9). Both peaks were also similar in the PF and HC groups (1.1-1.3 BW, P = .7-.8), and higher than the TF and MIX groups (P = .004-.02). For the second peak PF-JRF, only the HC group was higher than the TF group (P = .02). In the full sample, gait speed was related to all JRF peaks (r = 0.53-0.78, P<.01), while quadri-ceps strength was related to TF-JRF peaks (r = 0.33-0.34, P<.05). When gait speed and quadriceps strength were included as covariates, there were no differences for any JRF peak. In individuals with ACDs, JRF peaks were generally not related to knee function and activity level, and group differences persisted when accounting for these variables.CONCLUSIONS: Individuals with TF ACDs (TF and MIX groups) walked slower, which was associated with lower joint loads. Walking slower may be a protective gait modification to reduce load for individuals with TF ACDs, but was not observed in those with PF ACDS. Walking is likely a more provocative activity for TF ACDs compared to PF ACDs, as the TF joint is weight bearing throughout stance. Future work should exam-ine joint loading in tasks that engage the PF joint, such as stair climb-ing or squatting.CLINICAL RELEVANCE: Physical therapists should consider ACD location in selecting exercises and recommending activity modifications in individu-als with ACDs in the knee.

OPO225MESENCHYMAL STEM CELL FATE IS INFLUENCED BY RECRUITMENT OF MTORC2 TO THE CELL MEMBRANE BY MYOSIN MOTORSWilliam R. Thompson, Yong Li, Gunes Uzer, Janet RubinEndocrinology, Indiana University, Indianapolis, Indiana; Physical Therapy, Indiana University, Indianapolis, IndianaPURPOSE/HYPOTHESIS: Bone quality and quantity is inversely proportion-al to adipogenic commitment of marrow derived mesenchymal stem cells (MSCs), where increased adipogenesis depletes the progenitor pool for osteogenesis. Mechanical strain suppresses adipogenesis by activating a cascade involving Fyn, mTORC2, and Akt, culminating in both enhanced Beta catenin nuclear entry and cytoskeletal reinforcement. Previous work has demonstrated that this signaling cascade initiates at focal adhesion (FA) platforms, where strain recruits both Fyn and mTORC2 to amplify downstream responses; however, the mechanisms responsible for recruit-

may result in more symmetrical contact times, thus hiding potential limb differences that maybe related to power development.

OPO2233-YEAR OUTCOMES FOR PATIENTS WITH NECK AND BACK PAIN PARTICIPATING IN AN OPTIMIZED PHYSICAL THERAPY MANAGEMENT PROGRAMCharles A. Thigpen, Thomas R. Denninger, Allison Bell, Chad E. Cook, Timothy McHenryResearch and Analytics, ATI Physical Therapy, Greenville, South Carolina; Department of Orthopedics, Duke University, Durham, North Carolina; Department of Orthopedics, Greenville Health System, Greenville, South CarolinaPURPOSE/HYPOTHESIS: Previous research has demonstrated that early PT consultation for patients with low back pain improve outcomes and de-crease cost utilization. Additionally, physical therapy continues to be an underutilized part of care for patients with back and neck pain. The pur-pose of this study is to describe the 3-year outcomes of patients partici-pating in a novel Back and Neck program where Physical Therapy was optimally utilized.NUMBER OF SUBJECTS: The study involves 604 patients with neck and/or back pain who received guideline oriented care by physical therapists over a 3-year period.MATERIALS/METHODS: The data included patients who were seen via direct access or through referral. For all patients, patient report outcomes for pain, disability, depression, and quality of life were captured. Descriptive statistics examined average number of visits and change scores for mea-sured outcomes.RESULTS: Of the enrolled participants 440 were female (73%) and the sam-ple had an average age of 48.84 years. Of those enrolled, 197 (33%) had cervical complaints, 370 (61%) had lumbar complaints, and 33 (6%) had both. Twenty-nine percent of patients in cohort reported radiating symp-toms, 30% of the lumbar patients, and 32% of cervical patients. One hun-dred forty-eight (25%) of the patients were categorized as acute (symp-toms less than 90 days). Patients were seen on average for 6.8 visits. Patients demonstrated a 3.7 (95% CI: 3.411, 3.942; P<.0001) point reduc-tion on a numeric pain-rating scale, representing a 64% reduction from baseline. Patients demonstrated a 8.4 (95% CI: 7.216, 9.454; P<.001) and 7.0 (95% CI: 5.776, 8.286; P<.0001) point reductions on the Modified Oswestry Disability Index and Neck Disability Index, respectively. No sig-nificant changes in quality of life and depression were noted (P>.05).CONCLUSIONS: Our study demonstrates that patients entering a program where physical therapy is optimally utilized demonstrate significant re-ductions in pain and disability. Changes in pain and disability exceed-ed statistical significance, minimally clinically important difference, and 50% reduction threshold.CLINICAL RELEVANCE: This finding further supports the idea that PT should be utilized early in the care seeking episode of patients with back and neck pain and potentially at greater rates than is contemporary practice.

OPO224DIFFERENTIAL KNEE JOINT LOADING PATTERNS DURING GAIT FOR INDIVIDUALS WITH TIBIOFEMORAL AND PATELLOFEMORAL ARTICULAR CARTILAGE DEFECTS IN THE KNEELouise M. Thoma, Michael P. McNally, Ajit M. Chaudhari, Thomas Best, David C. Flanigan, Robert A. Siston, Laura C. SchmittSchool of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio; Physical Therapy, University of Delaware, Newark, Delaware; Division of Physical Therapy, The Ohio State University, Columbus, Ohio; Department of Family Medicine, OSU Sports Medicine, The Ohio State University, Columbus, Ohio; Department of Orthopedics, OSU Sports Medicine, The Ohio State University, Columbus, Ohio; Department of Mechanical and Aerospace Engineering, The Ohio State University,


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ROM were predictive of between-session changes.CONCLUSIONS: The hypothesis that between-session findings are an impor-tant form of early change, and can predict treatment success was sup-ported. This review disputes the idea that within-session changes are as strong of a clinical predictor for patient progress as patient’s between-session changes. Therefore, between-session changes are a more effective tool for determining patient plan of care.CLINICAL RELEVANCE: There is a need for an adequate tool or predictor that can effectively identify patients who will be strong responders to man-ual therapy focused interventions. Between-session changes offer more value than immediate or within session changes in predicting improve-ments. This review supports that a more effective tool for prediction should include between-session changes in treatment rather than imme-diate changes or anything specific to the patient at baseline. Future re-search should focus on the prediction value of between-session changes over CPR and immediate effect studies.

OPO227THE “HEMOPHILIA VERTICAL” PROJECT: FEASIBILITY OF THERAPEUTIC ROCK CLIMBING FOR PATIENTS WITH HEMOPHILIA AND PRE-EXISTING ARTHROPATHYLena M. Volland, Courtney Schroeder, Colleen Moran, Richard F. Barnes, Annette von DrygalskiHemophilia and Thrombosis Treatment Center, UC San Diego Health, San Diego, California; University of California San Diego, San Diego, CaliforniaPURPOSE/HYPOTHESIS: Hemophilia is a X-chromosome linked genet-ic disease, which, despite advances in prophylactic clotting factor re-placements, causes spontaneous joint and muscle bleeds and leads to debilitating arthropathy. Therefore, physical therapy and graded exer-cise programs have become critical interventions for this patient popu-lation to further improve upon joint health and enhance overall quali-ty of life (QoL). Generally, only low impact sports, such as swimming, walking, and yoga, have been deemed safe and thus, were recommend-ed by the National Hemophilia Foundation (NHF) and World Federation of Hemophilia (WFH). However, these activities were found to be bor-ing by many patients, which often lead to involvements in riskier sports, such as soccer, skiing, or football, potentially causing detrimental injuries. Consequently, there is a need for the development of more exciting yet safe treatment programs in a controlled environment. Therapeutic rock climbing has been widely used in Europe for various patient populations with muscular skeletal and neurological diseases and has shown signifi-cant physical and psychological health benefits. Thus, it may be a suitable alternative for patients with hemophilia. The aim of this study was to in-vestigate the feasibility of therapeutic rock climbing for patients with he-mophilia and preexisting arthropathy.NUMBER OF SUBJECTS: Six.MATERIALS/METHODS: Six male subjects with moderate to severe hemophil-ia A and preexisting arthropathy (mean ± SD age, 32.67 ± 7.15 years) par-ticipated in 12 sessions of therapeutic indoor top rope rock climbing. Each session was 2 hours long and followed a goal directed structure depend-ing upon participant’s abilities. The participants were instructed by a pro-fessional rock climbing instructor and supervised by a licensed physical therapist. Hemophilia Joint Health Score (HJHS), QoL (Haem-A-QoL and Hep-Test-Q), range of motion (ROM), and climbing skills (Yosemite Decimal Scale) were assessed pre and post rock climbing program. Bleeding episodes, factor usage, and pain reproduction (Borg Scale) were evaluated during the rock climbing program and compared to values ob-tain prior to the start of the project.RESULTS: All participants significantly improved upon their climbing skills without an increase in bleeding episodes, factor usage or pain reproduc-tion. Small improvements were noted in daily (Haem-A-QoL) and sport specific (Hep-Test-Q) QoL, HJHS, and ROM, with significant improve-ments in ankle mobility.

ing these signals to FAs is unclear. A mechanical strain induces actin cy-toskeletal stress fibers, while disruption of this structure prevents activa-tion of the Fyn/mTORC2/Akt cascade. Furthermore, visualization of Akt, using immunostaining, after mechanical strain, reveals Akt aligned in a pattern similar to actin cytoskeletal struts. These observations led us to hypothesize that recruitment of these upstream kinases to FA platforms requires movement along the actin cytoskeleton in response to strain.NUMBER OF SUBJECTS: Not applicable.MATERIALS/METHODS: Murine MSCs were isolated from marrow aspirates and cultured using alpha MEM with FBS and antibiotics. MSCs were plated on silicone bottomed 6-well dishes and subjected to biaxial me-chanical strain (2%, 100 cycles). Antibodies were used for immunoprecip-itation, followed by mass spec analysis or Western blotting. For Western blotting, 20.25 g of total cell lysate was loaded per well. Following poly-acrylamide gel electrophoresis, proteins were transferred to PVDF mem-branes, blocked with milk and probed overnight with primary antibodies. After a 2 hours of incubation with secondary antibodies, blots were ex-posed using ECL reagent.RESULTS: Myosins are molecular motors that carry “cargo” to intracellu-lar locations. Myosins also regulate cytoskeletal reorganization in adipo-cytes, suggesting a role in adipogenic commitment. Mass spec analysis, revealed a strong association of Rictor with both myosin 1C and myosin 9. Co-immunoprecipitation studies confirmed that both myosin 1C and myosin 9 bind Rictor. Importantly, mechanical strain enhanced the bind-ing of myosin 1C with Rictor, while the affinity of myosin 9 with Rictor was not affected.CONCLUSIONS: These data suggest that myosin 1C is a critical component of strain-induced recruitment of signaling effectors to the plasma mem-brane, where signal amplification restricts adipogenesis. As activation of signaling cascades that direct MSC lineage are temporally and spatial-ly regulated, force is necessary for spatial partitioning of Fyn/mTORC2/Akt. Myosin motors are necessary for carrying this “signaling cargo” to FAs, where force is transmitted, and subsequent signal activation occurs.CLINICAL RELEVANCE: This work seeks to identify the mechanisms by which MSCs sense mechanical force, and direct signaling molecules to focal con-tact points in the cell, where force is translated into biochemical signals that direct stem cell lineage fate to promote bone formation.

OPO226VALUE OF WITHIN-SESSION AND BETWEEN-SESSION FINDINGS FOR LONG-TERM OUTCOMES FOR PATIENTS RECEIVING MANUAL THERAPYCaroline L. Ubben, Ashlee Kim, Adam Dalbo, Mackenzie Eldridge, Chad E. CookOrthopedics, Duke University, Durham, North CarolinaPURPOSE/HYPOTHESIS: The purpose was to determine if early change leads to improved outcomes in patients who receive a manual therapy-orient-ed intervention. We hypothesized that early change carried over to a sub-sequent visit (between-session effects) will be more predictive of lon-ger-term improved outcomes than immediate effects (changes within a session).NUMBER OF SUBJECTS: Subjects involved individuals who received manual therapy treatment beyond 2 scheduled visits.MATERIALS/METHODS: Relevant databases were searched up to November of 2015. Studies were included if they were a cohort study or RCT with covariate control and longitudinal design. Outcomes measured includ-ed pain, range of motion (ROM), global rating of change (GRoC) and se-lect physical performance measures with variables assessed 96 hours af-ter initial visit. Risk of bias influencing internal and external validity and fidelity (quality and strength of the intervention provided) were separate-ly assessed.RESULTS: Seven studies met the inclusion criteria and were in included in the review. Early change in pain and GRoC were predictive of long-term improvements. Changes in disability were predictive of changes in pain, but not predictive of changes in function. Within-session changes in


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with LBP. However, as clinically relevant changes were found in some in-dividuals with LBP, future studies should aim to identify populations that respond to DN.

OPO229THE ASSOCIATION BETWEEN STATIC FOOT POSTURE AND HIP AND KNEE KINEMATICS DURING WALKINGDavid Werner, Joaquin BarriosUniversity of Dayton, Cincinnati, OhioPURPOSE/HYPOTHESIS: Abnormal foot kinematics may affect more proxi-mal mechanics of the lower extremity during weight-bearing tasks. While static foot postures have been related to foot and ankle mechanics, lit-tle is known regarding the relationships to the hip and knee. The Foot Posture Index (FPI) is a valid and reliable assessment of static foot pos-ture. Therefore, this study aimed to correlate FPI scores with 3-D hip and knee kinematics during walking.NUMBER OF SUBJECTS: Thirteen (8 female; mean ± SD age, 23.2 ± 1.09 years; weight, 70.0 ± 12.5 kg; height, 1.7 ± 0.09 m) healthy individuals provided bilateral data on 26 limbs.MATERIALS/METHODS: Each limb was assessed using the FPI by a board-certified orthopaedic physical therapist. The FPI is a 6-item observation-al and palpation-based assessment of static foot alignment, with higher positive values indicating a more pronated foot and lower negative values indicating a more supinated foot. Subjects were then fitted with an estab-lished retroreflective marker set bilaterally and performed 4 trials of lev-el walking at a speed of 1.5 m/s. Kinematic data were collected at 100 Hz using an 8-camera motion capture system, and reduced in Visual3D us-ing an x-y-z Euler rotation sequence. Pearson-product moment correla-tion coefficients were then calculated between FPI scores and 3-D hip and knee initial contact, excursion and peak angle data. An alpha level of .05 was applied for all significance testing.RESULTS: There were moderate positive correlations between FPI score and knee frontal plane angle at initial contact (r = 0.408, P = .04) as well as knee frontal plane excursion (r = 0.467, P = .016), such that increased pronation was related to increased knee abduction at initial contact and increased knee movement towards adduction during stance. There was also a moderate correlation between FPI score and maximum hip exten-sion during stance (r = 0.545, P = .004), such that increased pronation was related to increased hip extension.CONCLUSIONS: Increased pronation may contribute to increased dynam-ic valgus during weight bearing, accounting for some portion of the knee adduction movement during stance. Whereas, increased pronation may contribute to increased hip extension by allowing more time in late stance prior to push-off.CLINICAL RELEVANCE: Static foot posture related moderately to hip sagittal plane and knee frontal plane kinematics during ambulation. Clinicians identifying abnormal motions at the hip and knee may consider evalu-ation of static foot posture. As this study is cross-sectional, prospective studies are needed to evaluate if these relationships are causative.

OPO230THE RELATIONSHIPS OF TRUNK MUSCLE PERFORMANCE AND FOOT TYPE TO Y BALANCE PERFORMANCEDavid Werner, Joaquin BarriosUniversity of Dayton, Dayton, OhioPURPOSE/HYPOTHESIS: Lower extremity injuries can be both debilitating and costly. Efforts have been made to develop injury risk assessments, of-ten focusing on functional mobility. As an established mobility test, the Y Balance test has been shown to be prospectively related to injury risk in athletic and military populations. However, it is likely that underlying fac-tors such as strength and anthropometrics can influence Y Balance per-formance. Two such factors include trunk muscle performance and foot type. This study aimed to examine the relationship of trunk muscle per-formance and foot type to Y Balance performance.

CONCLUSIONS: Therapeutic rock climbing is feasible, safe and may consti-tute a valuable activity to be integrated into the physical therapy treat-ment regime. Additional investigations of its beneficial effects in a larger cohort are desirable.CLINICAL RELEVANCE: Due to improved medical treatment regimens pa-tients with hemophilia are aging, but will present with arthropathies and other comorbidities. Providing this population group with treatment pro-grams challenging their abilities, while contributing to their overall well-being in a safe environment is essential.

OPO228THE EFFECT OF DRY NEEDLING ON SPINAL MUSCLE FUNCTION, PAIN, AND DISABILITY IN INDIVIDUALS WITH MECHANICAL LOW BACK PAIN: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL USING SHEAR-WAVE ELASTOGRAPHYAmelia Weaver, Shane Koppenhaver, Tyler Randall, Ryan Hollins, Laurel Proulx, Brian A. Young, Jeffrey Hebert, Cesar Fernàndez de las PeñasUS Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Texas; Murdoch University, Murdoch, Australia; Universidad Rey Juan Carlos, Madrid, SpainPURPOSE/HYPOTHESIS: Lumbar muscle dysfunction is commonly implicat-ed in low back pain (LBP) [1-4]. Dry needling (DN) is an intervention aimed at treating painful musculoskeletal conditions and muscular dys-function [5-8]. However, no randomized controlled trials have assessed the effects of DN on lumbar muscle function, pain, and disability in pa-tients with LBP. The primary purpose of this study was to investigate the effects of DN on lumbar muscle stiffness at rest and during submaximal contractions in individuals with LBP and healthy people. Additionally we examined the short-term effects of DN on pain and related disability in those with LBP.NUMBER OF SUBJECTS: Ninety-one individuals (60 with mechanical LBP and 31 without current LBP) volunteered to participate (44 male; mean ± SD age, 31 ± 7 years).MATERIALS/METHODS: Subjects with LBP were randomly allocated to re-ceive true DN (n = 30) or sham DN (n = 30). Asymptomatic participants received true DN. Study outcomes included muscle stiffness, pressure al-gometry of the lumbar multifidus (LM) and paraspinal (PS) muscles, and the Oswestry Disability Index (ODI). Ultrasound shear wave elastography (SWE) was used to measure LM and PS stiffness at rest and during a sub-maximal contralateral arm lift while holding a small weight [9]. Images of the LM and PS muscles were captured at the right L4 level in asymp-tomatic subjects and on the painful side at the most painful level of the L3, L4, or L5 vertebral levels in patients with LBP. A single session of dry needling of the LM and PS muscles was performed at the right L4 level in asymptomatic individuals. True or sham DN was applied to the painful side at the most painful level of the L3, L4, or L5 levels in patients with LBP. All measures were obtained before and immediately after the DN in-tervention. Study outcomes were obtained immediately after and 1 week after treatment, except the ODI which was measured only at the 1-week follow-up. Between-group comparisons were analyzed using ANCOVAs with baseline scores as covariates.RESULTS: No significant differences were found in LM or PS stiffness be-tween any groups at either time point. However, a consistent trend indi-cated larger decreases (3%-11%) in stiffness in the true DN group com-pared to sham DN across both muscles and at both time points in patients with LBP. There were no consistent between-groups differences in study outcomes of pain or related disability.CONCLUSIONS: There were no clear differences in the efficacy of a single session of true DN versus sham DN on muscle stiffness, pain, and relat-ed-disability in patients with LBP. However, a consistent trend indicated larger decreases in stiffness in the true DN group compared to sham DN.CLINICAL RELEVANCE: A single session of DN does not appear to cause pre-dictable changes in muscle function or clinical improvement in patients


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gression (primary study purpose). Professional characteristics exam-ined (in regards to clinical decisions) were years of clinical experience (15+ years versus 0-15 years), highest physical therapy degree held (ie, BSPT/MPT versus DPT), yes versus no regarding Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and yes versus no regarding specialist certification from the American Board of Physical Therapy Specialties (ABPTS). McNemar test was utilized to examine secondary and tertiary purposes of the study (as listed in pur-pose/hypothesis section).RESULTS: Years of clinical experience and type of PT degree influenced the likelihood of several referral decisions. ABPTS certification was not as-sociated with referral decisions. FAAOMPT certification was associated with decreased likelihood of referral for MRI and neurosurgical consult. Greater myotomal deficit was correlated with greater likelihood of referral for MRI and neurosurgical consult and lower likelihood of initiating PT. The presence of imaging to confirm LDH was associated with increased likelihood of referral for neurosurgical consult.CONCLUSIONS: This survey suggests that demographic characteristics, greater myotomal deficit, and availability of MRI may influence clinical decisions regarding foot drop due to LDH.CLINICAL RELEVANCE: Professional characteristics may influence the likeli-hood of referral decisions. Severity of myotomal deficits may influence likelihood of referral decisions for additional imaging or neurosurgical consult amongst physical therapists. More quality evidence describing an optimal timeline or preferred plan of care for patients with this diagno-sis is needed. The association between MRI results and increased likeli-hood of neurosurgical consult supports current evidence that early imag-ing may be associated with greater future health care utilization.

OPO232THE INTRARATER RELIABILITY OF REHABILITATION ULTRASOUND IMAGING MEASUREMENTS OF THE SACRAL MULTIFIDUS IN HEALTHY SUBJECTS: A PILOT STUDYChristopher H. WiseDoctor of Physical Therapy Program, Alvernia University, Reading, PennsylvaniaPURPOSE/HYPOTHESIS: The purpose of this study was to explore the intra-rater reliability of obtaining Rehabilitation Ultrasound Images (RUSI) of the sacral multifidi muscles at rest and during a maximum voluntary con-traction (MVC) in healthy individuals with no report of low back pain.NUMBER OF SUBJECTS: Fifteen healthy, normal subjects between the ages of 18 and 65 years old.MATERIALS/METHODS: After signing an informed consent and obtaining an-thropometric data, each subject was placed in a prone position with a pil-low beneath the abdomen. Palpation of the inferior-most aspect of the right PSIS was performed and used as the initial starting point for ob-taining images of the multifidus at the level of S2. With the transducer placed horizontally, gel was applied and the image was obtained using the PSIS and median sacral crest as landmarks for identification of the multifidus at rest. The same process was utilized to obtain an image of the left multifidus. After obtaining images of both multifidi at rest, an im-age of right then left multifidus was obtained during the performance of an MVC against a manually-resisted isometric force into lumbar exten-sion. Two images were obtained both at rest and during a contraction for each subject, alternating between subjects. All measures were obtained in the same session by a single examiner who had minimal training in RUSI. Muscle thickness was determined by measuring the perpendicular distance between the superficial fascia and the deepest aspect of the mus-cle. Both intraimage, intrarater reliability (error associated with 1 exam-iner measuring sacral multifidus thickness on 1 ultrasound image) as well as interimage, intrarater reliability (error associated with the procedures used to obtain standardized image location and measurements from 2 separate ultrasound images) were determined.RESULTS: Good to excellent intrarater reliability (ICC3,3) with low SEM

NUMBER OF SUBJECTS: Twenty healthy subjects provided bilateral data on 40 limbs.MATERIALS/METHODS: Each subject performed the McGill Core Battery, the Y Balance test, and were assessed with the Foot Posture Index (FPI) by a board-certified orthopaedic physical therapist. The McGill Core Battery consists of 4 timed static holds to assess overall trunk muscle perfor-mance. The positions include a modified sit-up hold, a right and left lat-eral plank hold, and a prone extension hold with legs and pelvis support-ed on a plinth with straps and with the upper body off the plinth. Subjects held each positional hold to failure. The FPI is 6-item observational and palpation-based assessment of static foot alignment, with positive values indicating a more pronated foot and negative values indicating a more su-pinated foot. The Y Balance test is a series of 3 lower extremity reaching tasks (anterior, posterolateral, posteromedial) that are normalized to limb length and also combined to derive a composite score based on 3 success-ful reach trials in each direction. Pearson product-moment correlation co-efficients were calculated between the variables assessed, using a conser-vatively adjusted alpha level of .01.RESULTS: A moderate negative correlation was seen between FPI score and anterior reach of the Y Balance (r = –0.492, P = .001), suggesting that a more pronated foot is associated with reduced anterior reach. There were moderate correlations between lateral trunk endurance and Y Balance composite score when the stance leg of the Y Balance was ipsilateral (r = 0.516, P<.001) or contralateral (r = 0.510, P<.001) to the side tested in the lateral plank hold. Regardless of stance limb, lateral trunk muscle perfor-mance was related to performance of the Y Balance test.CONCLUSIONS: Greater foot pronation may compromise dynamic stability on the stance leg due to a medialized center of pressure. Greater levels of lateral trunk muscle performance may assist individuals in maintaining body positions needed for dynamic lower extremity reach tasks required for Y Balance.CLINICAL RELEVANCE: The results of this study suggest that trunk muscle per-formance and pronation-supination foot type are related to lower extrem-ity functional mobility. Clinicians may consider assessing trunk muscu-lature and foot type when patients demonstrate reduced lower extremity functional mobility. However, as the correlations were moderate, other fac-tors that contribute to Y Balance performance should also be considered.

OPO231CURRENT DECISION MAKING OF PHYSICAL THERAPISTS IN THE MANAGEMENT OF PATIENTS WITH FOOT DROP SECONDARY TO NERVE ROOT COMPROMISE DUE TO ACUTE LUMBAR DISC HERNIATION: A SURVEY STUDYAdam Wielechowski, Aaron Keil, Karrie Hamstra-Wright, Yi-Fan ChenPhysical Therapy, University of Illinois at Chicago, Chicago, Illinois; University of Illinois at Chicago, Chicago, IllinoisPURPOSE/HYPOTHESIS: The primary purpose was to examine the associ-ation of professional experience level of PTs with referral decisions re-garding magnetic resonance imaging (MRI), neurosurgical consult, and initiation of formal physical therapy for suspected acute lumbar disc herniation (LDH) with myotomal involvement. A secondary purpose of this study was to examine if there was an association between severity of myotomal deficit (presumed to be due to LDH) and likelihood of refer-ral for each of the 3 respective categories. Lastly, identical clinical sce-narios were compared both with and without presence of MRI findings to confirm clinical diagnosis of LDH to examine if there was an associa-tion between availability of MRI results and physical therapists’ referral for neurosurgical consult.NUMBER OF SUBJECTS: Sixteen thousand six hundred twenty-six members of the orthopaedic section of the APTA were surveyed. The survey response rate was 13.2% (n = 2172).MATERIALS/METHODS: The association between demographic characteris-tics and clinical questions was assessed using multivariable logistic re-


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shoulder last years was not supported in these cases.CLINICAL RELEVANCE: A pragmatic approach that directs treatment to re-lated regions beyond the shoulder joint may provide benefits in cases of frozen shoulder. Controlled study of the effects of a pragmatic regional interdependence treatment approach on ROM and function in frozen shoulder patients is warranted.

OPO234THE EFFECT OF SPINAL MANIPULATION ON BREATHING PATTERN AT RESTMarlon L. Wong, Teresa K. Glynn, David A. Mcapline, Yusuf Masri, Meira Weiss, Nicholas White, Marlon Pereira, Ryan Martinson, Lawrence P. CahalinPhysical Therapy, University of Miami, Palmetto Bay, FloridaPURPOSE/HYPOTHESIS: The effects of spinal manipulation (SM) are known to have neurophysiologic effects. Breathing pattern (BP), is thought to have a bidirectional relationship with autonomic nervous system (ANS). Moreover, abnormal BP and hypocapnia have been associated with low back pain. BP was defined in this study as respiration rate (RR), tidal vol-ume (VT), and minute ventilation (VE). The purpose of this study was to assess the effect of SM on BP in healthy subjects.NUMBER OF SUBJECTS: Eighteen.MATERIALS/METHODS: Subjects underwent breath-by-breath respiratory gas analyses (RGA) for 15 minutes in supine before and after receiving SM targeting the thoracic spine. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were also measured. Statistical anal-yses included Wilcoxon signed-rank tests to compare RGA before and af-ter SMT, and independent samples Mann-Whitney U tests to compare subjects with MIP and MEP values less than or greater than 120 cmH2O.RESULTS: Analysis of the entire sample revealed a statistically significant decrease in VE after SMT (5% decrease, P = .01), but no significant dif-ference in any other variables. However, BP after SM was significantly (P<.05) different in subjects with MIP and MEP values greater than 120 cmH2O compared to those with values less than 120 cmH2O. Subjects with MIP less than 120 cmH2O demonstrated an 8% decrease in VE, whereas those with MIP greater than 120 cmH2O demonstrated a 2% increase in VE after SMT (P = .006). Significant (P<.05) differences in RGA of subjects with MEP less than 120 cmH2O compared to subjects with MEP greater than 120 cmH2O after SMT were found for RR (2% in-crease versus a 6% decrease, respectively; P = .04), VT (12% decrease ver-sus 5% increase, respectively; P = .005), and VE (8% decrease versus 1% decrease, respectively; P = .04). Dichotomized MIP and MEP groups did not differ in regards to sex, expectations, or baseline BP measures.CONCLUSIONS: SM appears to decrease VE, but MIP and MEP performance appear to have a potential modifying effect on BP after SM. The results of this study suggest that subjects with more robust ventilatory systems (ie, MIP and MEP values greater than 120 cmH2O) tend to respond to SM by slowing RR and increasing VT, which is often a desired BP response and commonly associated with diaphragmatic breathing or breathing exer-cises for stress reduction. However, subjects with maximal pressure less than 120 cmH2O had an opposite response, with slight elevations in RR and decreased VT. The cutoff point of 120 cmH2O is approximately the age predicted normal value for this cohort (confidence interval: 116, 140), and may be a useful biomarker for predicting BP response to SM.CLINICAL RELEVANCE: Better understanding of the underlying mechanisms, as well as mediating and modifying factors, may allow practitioners to better predict BP response to SM. Due to the known neurophysiologic ef-fects of SM, bidirectional relationship with breathing and the ANS, and known association of altered BP and spinal pain conditions, understand-ing BP response to SM may provide additional insight into the often dis-parate responses to SM between patients, and help improve patient selec-tion and outcomes with SM.

scores were established for intraimage and interimage RUSI measure-ments of bilateral sacral multifidi.CONCLUSIONS: Intrarater reliability was demonstrated for obtaining mea-sures of the sacral multifidus at rest and during an MVC using RUSI.CLINICAL RELEVANCE: Rehabilitation Ultrasound Imaging is gaining accep-tance and may be used by Physical Therapists to measure deep muscle function in real-time during functional tasks. Good reliability for RUSI measurements of the transverse abdominis and lumbar multifidus has been determined by several authors. The results of the present study pro-vide additional reliability data for the use of RUSI in the measurement of the sacral multifidus muscle at rest and during an MVC. These re-sults support the use of RUSI for assessing the morphology of this mus-cle, which may be used to quantify the response of the sacral multifidus to injury and to evaluate the impact of therapeutic interventions on mus-cle function.

OPO233A PRAGMATIC REGIONAL INTERDEPENDENCE APPROACH TO FROZEN SHOULDER: A CASE SERIESChristopher K. Wong, Elizabeth Mercer, Galen Schram, Rebecca Kesting, Bryanna Strang, Karambir DeoProgram in Physical Therapy, Columbia University, New York, New YorkPURPOSE/HYPOTHESIS: Frozen shoulder is known for slow improvement with motion deficits that last for years. No physical therapy treatments listed in a recent clinical practice guideline—all directed at the gleno-humeral joint—received a Grade A recommendation, including patient education or stretching (Grade B), and modalities or joint mobilization (Grade C). The purpose of this case series was to describe the pragmat-ic application of a regional interdependence approach for frozen shoul-der and synthesize outcomes. Secondary purposes were to assess wheth-er (1) final shoulder range of motion (ROM) approached normal values, (2) ROM changes followed a time-related pattern, and (3) functional out-comes were maintained at follow-up.NUMBER OF SUBJECTS: Five.MATERIALS/METHODS: This retrospective case series analyzed existing data from consecutive patients referred with frozen shoulder diagnoses with-in 1 year. After confirming the diagnosis with clinical findings, 1 physi-cal therapist used a pragmatic regional interdependence approach that included treatment to the shoulder girdle (sternoclavicular and acro-mioclavicular joints, first rib), shoulder (glenohumeral joint, rotator cuff muscles), scapula-thoracic/humeral-thoracic (pectoralis major/mi-nor, latissimus dorsi, serratus anterior muscles); and cervical-thoracic/costovertebral joints. A pragmatic treatment approach allows select in-terventions chosen based on clinical impairments identified by the cli-nician. Interventions included joint mobilizations (grades III-V, mobili-zation with movement, strain-counterstrain, muscle energy techniques), soft tissue mobilization, muscle stretching and strengthening, patient education, and modalities and aerobic warm-ups. Outcomes included shoulder ROM upon discharge and the Disability of Arm, Shoulder, and Hand (DASH) functional outcome measure at approximately 4 weeks follow-up.RESULTS: Subjects came for 11 to 21 sessions (mean, 15) over 4 months. All subjects improved on all outcomes, thus group means were reported. ROM increased for flexion (117° ± 10° to 179° ± 12°, d = 5.9), abduction (74° ± 8° to 175° ± 9°, d = 9.3), and external rotation (23° ± 7° to 89° ± 2°, d = 12.0) with large effect sizes at discharge. DASH scores at mean 11 months post-discharge improved from 40.0 ± 19.4 at evaluation to 6.2 ± 3.7 at follow-up (d = 1.5), exceeding the minimal clinically important difference.CONCLUSIONS: A pragmatic regional interdependence approach yielded large effect size ROM and shoulder function improvements for 5 patients with frozen shoulder. Final ROM approached normal values-with most gains achieved early and large effect size functional outcomes were evi-dent months after discharge. The conception that ROM deficits in frozen


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discrimination due to being homeless have been shown to cause negative experiences that decrease the likelihood of the homeless seeking servic-es. The Mobile Clinic Project (MCP) is an interprofessional collaboration among medical students, public health graduate students, and under-graduate students which has been providing weekly street-side medical and social support services to the homeless in West Hollywood, CA for 16 years. In 2014, approximately one third of cases were musculoskele-tal (MSK) complaints. Therefore, we hypothesized that physical therapy (PT) would contribute to the medical care and health promotion goals of the MCP. The purpose of this study was to determine the need for and fea-sibility of providing street-side PT services to the homeless community.NUMBER OF SUBJECTS: One hundred eighty-seven clients were served at the MCP during the study period.MATERIALS/METHODS: First- and second-year student physical therapists (SPTs) (n = 13) from a Doctor of Physical Therapy program participated in 10 MCP clinics from November 2015 to June 2016. One to 2 clinical faculty members supervised and mentored the SPTs, who worked along-side the medical students and undergraduates to provide care and deter-mine need for additional services or referrals. If PT services were recom-mended, the SPT performed a PT evaluation and treatment under the direct supervision of the attending PT and documented care in the cli-ents’ clinic chart.RESULTS: The client demographics were as follows: average ± SD age, 49.8 ± 12.0 years; 68.9% male, 31.2% female; 52.5% Caucasian, 21.3% Hispanic, 21.3% African American, 3.3% Asian/Pacific Islander; 31.6% of clients reported an MSK condition as their chief complaint; 78.7% of the PT-appropriate cases were MSK (17.3% upper quarter, 30.7% spine, 30.7% lower quarter). The nonMSK, PT-appropriate cases were neuro-logic, such as multiple sclerosis, spinal cord injury, peripheral neuropa-thy, and lumbar myelopathy. Follow-ups accounted for 23.7% of PT visits.CONCLUSIONS: The high prevalence of homeless clients seeking medical care at the MCP for MSK conditions suggests a strong need for inclusion of PT in medical clinics that serve this population. As 23.7% of the PT visits were follow-ups, the potential exists for developing a consistent PT practice at the MCP. While further research is needed on the short and long-term impact of PT on MCP clients’ health and functional outcomes, existing studies suggest enhancing homeless patients’ functional mobil-ity and decreasing activity limitations may lead to improved community participation and reduce high risk behaviors.CLINICAL RELEVANCE: The Los Angeles Homeless Services Authority (LAHSA) reported the total homeless population in Los Angeles County in 2015 was 44 359 and homeless with physical disability was 8148. This study shows the need for and feasibility of providing street-side PT to improve function and mobility in this vulnerable population.

OPO237RELATIONSHIP BETWEEN HIP ISOMETRIC MUSCLE STRENGTH AND DYNAMIC POSTURAL CONTROL IN HEALTHY PARTICIPANTSAdam W. Yoder, Lindsey Doan, Cameron Freund, Chelsea MoreyPhysical Therapy, University of Saint Mary, Leavenworth, KansasPURPOSE/HYPOTHESIS: Lower extremity injuries are common in physically active individuals. Hip strength influences lower extremity injury in the physically active. Dynamic balance impairments, which may be identified using the Star Excursion Balance Test (SEBT) or the modified SEBT, have also been associated with lower extremity injury. However, little is known about whether hip muscle strength impacts an individual’s dynamic-bal-ance capabilities. Thus, the purpose of this study was to investigate the re-lationship between hip muscle strength and dynamic balance in healthy individuals with the SEBT.NUMBER OF SUBJECTS: Nineteen.MATERIALS/METHODS: Hip muscle force was tested in 19 young healthy in-dividuals (10 male, 9 female; height, 174 ± 9.9 cm; weight, 88 ± 31.33 kg) with a handheld electronic dynamometer (Newtons) for hip flexion,

OPO235RESTING HEART RATE AND HEART RATE RECOVERY DIFFER BASED ON PAIN MECHANISM CLASSIFICATIONMarlon L. Wong, Juan P. Gonzalez, Nelson Treto, Chelsea A. Miller, Katherine Espinosa, Lawrence P. CahalinPhysical Therapy, University of Miami, Palmetto Bay, FloridaPURPOSE/HYPOTHESIS: There is conflicting evidence in regards to the asso-ciation of cardiovascular risk factors and low back pain (LBP). Previous studies on this relationship have either looked at LBP as a homogenous group, or distinguished between localized versus radiating symptoms. It has been advocated that viewing LBP patients as a heterogeneous group, and categorizing them based on neurophysiological pain mechanisms [nociceptive (NO), neuropathic (PN), and central sensitization (CS)] may improve both clinical and research outcomes. The purpose of this study was to assess if patients with constant LBP, of at least 1 month du-ration, differed in resting vital signs and heart rate recovery (HRR) based on their pain mechanism classification. It was hypothesized that sub-jects categorized as NO would have lower resting heart rate (RHR), lower blood pressure (BP), higher peak heart rate (PHR) and a higher heart rate recovery (HRR) than those in the PN and CS pain mechanism groups. Furthermore, subjects with PN pain would have lower HR, BP, and high-er PHR and HRR than subjects with CS.NUMBER OF SUBJECTS: Fifteen subjects with constant LBP were consecu-tively recruited from an outpatient physical therapy clinic.MATERIALS/METHODS: Subjects first received a brief interview and phys-ical examination to determine pain mechanism category. The Pain Catastrophizing Scale (PCS), Oswestry Disability Index (ODI), and nu-meric pain-rating scale (NPRS) were then administered. Resting BP and HR data were collected. One minute HRR was assessed after 15 minutes of walking at a self-determined pace on a treadmill. Subjects were instructed to walk at a brisk pace that they could maintain for the entire 15 minutes.RESULTS: Independent-samples Krustal-Wallis tests (P<.05) were used to assess distribution across groups. Groups did not differ for age, sex, BMI, number of comorbidities, or chronicity. Groups also did not differ for rest-ing systolic or diastolic BP, PCS, ODI, or NPRS for current, best, or worst pain level. However, significant differences between groups were noted for RHR (averages of 79 for NO, 78 for PN, and 65 bpm for CS), PHR (av-erages of 105 for NO, 95 for PN, and 88 bpm for CS), and HRR (averages of 20 for NO, 12 for PN, and 11 for CS). No statistical difference was found for heart rate reserve (PHR-HR) between groups.CONCLUSIONS: As expected, PHR and HRR were highest in the NO group and lowest in the CS group. Contrary to expectations, resting HR was highest in the NO group and lowest in the CS group, and groups did not differ in regards to BP.CLINICAL RELEVANCE: Attenuated HRR after exercise is thought to be a marker of reduced parasympathetic activity and is an independent pre-dictor of all-cause mortality. PHR and HRR after a simple self-selected walking test may also provide important information for pain mechanism classification and prognostication in patients with constant LBP.

OPO236INCLUSION OF PHYSICAL THERAPY IN AN INTERPROFESSIONAL HEALTH PROGRAM SERVING THE HOMELESS POPULATION IN LOS ANGELES: A NEEDS AND FEASIBILITY STUDYNoriko Yamaguchi, Kenneth Kim, Alyssa Uemura, Eric Tam, Walter CoppenrathBiokinesiology and Physical Therapy, University of Southern California, Los Angeles, California; David Geffen School of Medicine, University of Southern California, Los Angeles, Los Angeles, California; Family Medicine, Kaiser Permanente, Los Angeles, CaliforniaPURPOSE/HYPOTHESIS: Competition with basic needs such as food and shel-ter is a barrier to the homeless accessing health care, and perceptions of


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ers remained 1.9 s slower than the nonfallers 6 months after TKA.CONCLUSIONS: Despite the consistent reduction in pain and improvements in self-reported function, physical function and strength remains lower in fallers before and after TKA. Although we did see that the fallers had a significantly better improvement in the TUG, it is likely that this improve-ment is related to the low ceiling effect for this measure. The fallers sim-ply had more room to improve, given their poor preoperative TUG scores.CLINICAL RELEVANCE: Despite significant functional improvements after TKA, individuals who experienced a fall prior to TKA have persistently lower physical function. These individuals may require additional train-ing to restore normal levels of physical performance and strength.

OPO239MAGNITUDES OF MUSCLE ACTIVATION OF SPINE STABILIZERS IN HEALTHY ADULTS DURING PRONE ON ELBOW PLANKING EXERCISES USING A FITNESS BALLJames W. Youdas, Kendra C. Coleman, Erin E. Holstad, Stephanie D. Long, Nicole L. Veldkamp, John H. HollmanProgram in Physical Therapy, Mayo Clinic, Rochester, MinnesotaPURPOSE/HYPOTHESIS: This study quantified muscle activation [percent maximum voluntary isometric contraction (MVIC)] of the right iliocos-talis lumborum (IL), longissimus thoracis (LT), lumbar multifidi (LM), latissimus dorsi (LD), gluteus maximus (GM), hamstrings (HS), rectus abdominis (RA), external oblique (EO), internal oblique (IO), and serra-tus anterior (SA) during 4 planking procedures: (1) prone plank on floor (PPOF), (2) prone plank on ball (PPOB), (3) stir-the-pot on ball (STP), and (4) prone plank on ball with hip extension (PPHE). Previous investi-gators have not studied STP and PPHE. We hypothesized STP and PPHE would generate the highest levels of electromyographic (EMG) activity because of the concomitant demand for trunk stability and distal mobil-ity of the extremities.NUMBER OF SUBJECTS: Twenty-six healthy subjects volunteered to partici-pate: 13 males (mean ± SD age, 25.4 ± 5.7 years) and 13 females (age, 25.0 ± 3.8 years).MATERIALS/METHODS: This study used a repeated measures within-subjects design for each muscle. Subjects performed each of 4 exercises using a randomized testing sequence. Muscle recruitment levels (percent MVIC) were obtained concurrently from muscles of the right side. Stability balls were used and inflated for each subject according to the manufacturer’s recommendation. During the testing session each subject performed a 10-second hold for exercises 1 (PPOF) and 2 (PPOB) because they in-volved a static hold. Exercises 3 (STP) and 4 (PPHE) also lasted 10 sec-onds with 3 repetitions of circular clockwise rotations (STP) or right leg lifts (PPHE). Data were sampled at a frequency of 1000 Hz. Raw EMG signals were band-pass filtered and subsequently processed with a root-mean-square algorithm using moving windows with 125 milliseconds time constants. EMG data collected during the planking tests were nor-malized to the muscles’ respective MVIC trials, and expressed as a per-centage of the MVIC. Peak activation for each muscle was calculated from the normalized data using a 200-millisecond window about the peak.RESULTS: Data from each muscle were examined with a repeated measures analysis of variance (ANOVA) at α = .05. Post hoc comparisons of EMG recruitment across exercises for statistically significant ANOVAs were conducted with Bonferroni corrections for multiple comparisons. During STP, 3 muscles (RA, EO, IO) demonstrated very high (greater than 61% MVIC) EMG activation and 1 muscle (SA) demonstrated high (41%-60% MVIC) EMG activation. During PPHE, 5 muscles (GM, HS, EO, IO, LM) demonstrated very high EMG activation and 2 muscles (RA, SA) demon-strated high EMG activation.CONCLUSIONS: STP and PPHE are effective at strengthening multiple core muscles and are reasonable to include in a strengthening program.CLINICAL RELEVANCE: STP and PPHE pose a unique challenge to the core muscles by introducing both unstable and stable components during a dynamic activity, resulting in a greater number of muscles activated (per-

external rotation, abduction, and extension. Individuals then performed the SEBT in the anterior, posterolateral, and posteromedial direction (re-corded as a percent of the individual’s leg length in centimeters). Pearson product correlations examined the relationship between hip muscle strength and performance of the SEBT.RESULTS: No correlation was found between individual muscle strength and performance of the SEBT in the anterior, posteromedial, and pos-terolateral directions, or the total composite scores of the SEBT (P>.05).CONCLUSIONS: Hip isometric strength is not correlated with dynamic bal-ance, as measured by the SEBT. Other factors, such as lumbopelvic en-durance and hip, knee, and ankle range of motion, or an individual’s pro-prioception, may have a greater effect on dynamic balance than isometric strength of isolated hip muscles. Further research should be done with a larger sample size, as well as different age groups, to determine if there is a link between hip strength and dynamic balance.CLINICAL RELEVANCE: Physical therapists are responsible for identifying risk factors for lower extremity injuries, managing lower extremity injuries, and determining if an athlete is safe to return to their sport. According to this study, hip strength alone is not correlated to performance on the SEBT. Clinicians should consider other factors, such as balance and low-er extremity range of motion, when developing rehabilitation programs for athletic populations.

OPO238PATIENTS WITH A FALL HISTORY HAVE WORSE FUNCTION AND STRENGTH BEFORE AND AFTER KNEE ARTHROPLASTYYuri Yoshida, Adam R. Marmon, Joseph ZeniDepartment of Physical Therapy, University of Delaware, Newark, DelawarePURPOSE/HYPOTHESIS: Falls are a primary concern among older adults with orthopaedic impairments. Approximately 45% of individuals after total knee arthroplasty (TKA) experienced a fall prior to surgery will fall again within 1 year of TKA. Although the prevalence of falls is high, it is not known whether falling prior to TKA predisposes individuals to a worse outcome after surgery. We hypothesized that individuals who experienced a fall prior to their TKA will have persistently lower physical function compared to those who did not fall prior to TKA.NUMBER OF SUBJECTS: One hundred twenty-three participants who under-went TKA (mean ± SD age, 66.3 ± 8.3 years; BMI, 33.2 ± 15.5 kg/m2).MATERIALS/METHODS: Functional outcomes were assessed 2 to 4 weeks pri-or to TKA and 6 months after TKA. These included the Knee Outcome Score (KOS), knee range of motion (ROM), Timed Up and Go (TUG), Stair Climbing Test (SCT), 30-second Chair Rise Test (30SCRT), and 6 Minute Walk Test (6MWT). Maximum Isometric quadriceps strength was also measured. All participants were categorized as a faller or nonfaller based on the response to “Have you experienced a fall in the previous 6 months?” which was asked at preoperative testing. Repeated-measures ANOVAs were used to determine differences between groups and be-tween time points. In the presence of an interaction effect, follow-up t tests were performed.RESULTS: Twenty participants experienced a fall prior to their TKA. There were no significant interaction effects for age, BMI, 30SCRT, 6MWT, and strength (all approximately .05). There were no main effects for age, BMI, pain and ROM. There were main effects for time for the KOS (t = 33.3, P≤.01), 30SCRT (t = 3.0, P≤.01), 6MWT (t = 70.9 m, P≤.01), and strength (t = 14.7%, P = .02), which indicated all participants significantly improved after TKA regardless of group assignment. There were main ef-fects of group for KOS (difference, 7.0; P = .02), 30SCRT (difference, 1.7; P = .03), 6MWT (difference, 62.0 m; P = .02), and strength (difference, 23.3%; P≤.01), which indicated that the fallers had lower functional out-comes and weaker quadriceps compared to the nonfallers regardless of the testing session. There was a significant interaction effect for TUG (P = .04). Post hoc analysis revealed that the nonfallers improved 0.9 s after TKA (P≤.01), while the fallers improved 2.1 seconds (P≤.01), but the fall-


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Residency Programs, Sacred Heart University, Fairfield, Connecticut; Doctor of Physical Therapy Program, Azusa Pacific University, Azusa, California; Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut; Orthopedic Physical Therapy Residency Program, Kaiser Permanente, Panorama City, CaliforniaPURPOSE/HYPOTHESIS: The study aims to explore whether: (1) identical low dose lateral glides (LAT) or posterior pressures (AP) is more effective in altering neck disability, pain, range of motion (ROM) and (2) if the proce-dures cause sympathoexcitation or inhibition in patients with acute neck pain (NP). LAT and AP appear efficacious for NP. In individuals with-out NP, AP and LAT were shown to have divergent cardiovascular re-sponses (CR). The neurophysiologic system that modulates pain overlaps with blood pressure (BP) and sympathoexcitation seems to mediate pain. However, it is not known whether AP and LAT results in analogous or dissimilar functional and clinical (includes CR) outcomes.NUMBER OF SUBJECTS: Twenty-two patients (10 female; mean ± SD age, 27.09 ± 9.43 years) with NP participated.MATERIALS/METHODS: Each individual is randomly allocated to 1 of 2 groups. Group 1 and Group 2 obtained AP and LAT respectively to the most tender and restricted segment. First, baseline neck and shoulder ROM with numeric pain rating scale (NPRS), and Neck Disability Index (NDI) were collected. Then, a monitor measured the systolic (SBP), di-astolic (DBP) blood pressure and heart rate (HR) recording the follow-ing time points: (1) 5 minutes, and (2) 7 minutes after lying supine; (3) during the first set, and (4) fifth set of 1 of the glides; (5) 2 minutes after time point 4, and (6) 4 minutes after time point 4. Bonferroni corrections were applied for repeated analyses. Following time point 6, global rat-ing of change was obtained based on the neck and shoulder ROM retest. Finally, follow-up NPRS and NDI were obtained within 1 week.RESULTS: ANOVA indicates that AP and LAT have the following respective significant findings: cervical spine (CS) rotation to the left ROM is altered by a mean ± SD of –0.80 ± 4.50 compared to 6.90 ± 9.70 (η2 = 0.22; medi-um-large effect size); NPRS “at best” increased by a mean of 0.4 ± 1.0 ver-sus a decrease by a mean of –0.6 ± 1.2 (out of 10). CS extension ROM also altered by an average of +3.40 ± 6.80 for AP compared to –1.60 ± 5.70 for LAT (η2 = 0.15, P = .07), trending statistical significance favoring AP. As for the within-group comparisons, follow-up NDI improved (P<.05) 24% for AP and 37% for LAT. The improved mean NPRS “at worst” for AP is –1.8 ± 2.9; for LAT is –1.4 ± 2.2 (out of 10). In addition, some statistical clinically noteworthy CR were found: (1) in the AP group, the HR dimin-ished by an average of 3.6 ± 2.8 bpm from time point 1 to 3; and (2) in the LAT group, the mean DBP reduction is 2.2 ± 1.5 mmHg from time point 2 to 4. Finally, within the LAT group, shoulder elevation ROM average in-crease was 11.60° ± 9.60° (P<.05).CONCLUSIONS: Both low-dose LAT and AP improved neck disability with analogous sympathoinhibitory CR within 1 week. Furthermore, LAT im-proved CS rotation ROM more than AP.CLINICAL RELEVANCE: Therefore, a subset of patients with NP and high BP may potentially benefit from low dose LAT (or AP) to improve function without further increasing BP but this requires further research.

OPO242CLINICAL MEASURES RELATE TO TENDON MECHANICAL PROPERTIES FOLLOWING ACHILLES TENDON RUPTUREJennifer A. Zellers, Laura Pontiggia, Daniel H. Cortes, Karin G. SilbernagelProgram in Biomechanics and Movement Science, University of Delaware, Newark, Delaware; Department of Mathematics, Physics, and Statistics, University of the Sciences, Philadelphia, Pennsylvania; Department of Mechanical and Nuclear Engineering, Penn State University, State College, Pennsylvania; Department of Physical Therapy, University of Delaware, Newark, Delaware

cent MVIC) at strengthening levels not observed with static planking ex-ercises (PPOF and PPOB).

OPO240CRITERION VALIDITY OF SHEAR-WAVE ELASTOGRAPHY COMPARED TO ELECTROMYOGRAPHY TO ASSESS LUMBAR MULTIFIDUS ACTIVATIONBrian A. Young, Christine M. Kasprisin, Madeline Merriam, Robert McNeal, Cameron Harms, Elizabeth Painter, Mark E. Lester, Shane KoppenhaverPhysical Therapy, US Army-Baylor University, Schertz, TexasPURPOSE/HYPOTHESIS: Low back pain is the most common cause of mus-culoskeletal health care visits among military personnel. Dysfunction in lumbar multifidus activation has been associated as a factor contribut-ing to low back pain. The gold standard for muscle activation assessment has been electromyography (EMG); however, the invasive nature of EMG can be challenging for patients and providers [2]. Ultrasonic ShearWave Elastography (SWE) has emerged as a noninvasive technique to quantify tissue stiffness, and has been shown to be related to superficial muscle ac-tivity [3-5]. The purpose of this study was to evaluate the validity of SWE muscle activation in comparison to EMG during various lumbar multifi-dus contraction intensities.NUMBER OF SUBJECTS: Fourteen asymptomatic individuals were enrolled.MATERIALS/METHODS: The right L4 lumbar multifidus was located with B-mode ultrasound with the transducer oriented in parallel with the mus-cle fibers [1]. Muscle stiffness (shear modulus in kilopascals) was assessed via the Aixplorer ShearWave (Supersonic Imagine, Aix-en-Provence, France) during rest, low, moderate, high and maximal isometric con-tractions [2]. Concurrently, lumbar multifidus activation was measured with fine wire electromyography using the Noraxon MR 3.8.6 software (Noraxon, USA Inc. Scottsdale, AZ). The EMG wire and insertion site were separated from the SWE transducer with 3MTM Tegaderm dress-ing. Three trials were captured for each condition. EMG contraction was converted to percent maximal voluntary isometric contraction.RESULTS: Five subjects were excluded, 1 due to EMG instrumentation er-ror, and 4 due to the inability of SWE to adequately capture lumbar mul-tifidus stiffness. The remaining 9 subjects (6 female) had an average ± SD age of 26 ± 3.71 years and BMI of 22.7 ± 1.38 kg/m2). A 1-by-5 repeat-ed-measures ANOVA revealed a statistically significant main effect for muscle contraction for both EMG and SWE. Bonferroni post hoc analy-sis for SWE yielded a statistically significant difference between rest and low, moderate and max levels (P≤.035). Bonferroni post hoc analysis for EMG yielded a statistically significant difference between rest and all con-traction levels (P≤.004), and between max and all levels (P<.001). Visual analysis of SWE data suggested a curvilinear relationship across contrac-tion levels. Muscle stiffness as measured by SWE showed fair correlation with EMG at the L4 multifidus level (r = 0.350, P = .020). When analyz-ing rest, low and moderate contractions only, the correlation was moder-ate (r = 0.593, P = .001).CONCLUSIONS: Use of SWE to assess lumbar multifidus activation appears to be a potentially valid, noninvasive measure of muscle activation at low-er levels of muscle contraction. Further work assessing SWE response across the entire range of muscle contraction is warranted.CLINICAL RELEVANCE: SWE is a potential alternative for noninvasive, real-time assessment of deep spinal musculature. With clarifying work, SWE may eventually substitute when EMG or magnetic resonance imaging is considered to assess muscle response to exercise or treatment.

OPO241SYMPATHOINHIBITION CAN IMPROVE FUNCTIONAL AND CLINICAL OUTCOMES IN ACUTE NECK PAIN: PRELIMINARY FINDINGS OF A RANDOMIZED CLINICAL TRIALEmmanuel Yung, Michael Wong, Muhammad I. Ali, Allison Breakey, Erica Barton, Kelly Peterson, Karen ChingDoctor of Physical Therapy and Orthopedic Physical Therapy


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Giorgio Zeppieri, Katie M. Davis, Michael W. Moser, Kevin W. Farmer, Steven GeorgeUF Health, Gainesville, Florida; University of Florida, Gainesville, FloridaPURPOSE/HYPOTHESIS: There is growing evidence linking psychosocial risk factors to poor outcomes following musculoskeletal injury. As a result there is growing interest in determining whether psychosocial screening can identify athletes at risk for prolonged sport disability. The purpose of this study was to examine the predictive relationship between 3 estab-lished psychosocial risk factors and time lost from sport after musculo-skeletal injury.NUMBER OF SUBJECTS: A prospective study of 30 Division I softball players over 2 competitive seasons.MATERIALS/METHODS: At the beginning of each season subjects completed the Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), and the Fear Avoidance Belief Questionnaire (FABQ), which was modified to address the subject’s global musculoskeletal pain condition rather than a specific condition. Subjects were then followed over the sea-son and time (number of days [practice and game]) missed due to mus-culoskeletal injury was recorded. Independent samples t test were per-formed to assess the difference in psychosocial scores for athletes who missed time due to musculoskeletal injury. Chi-square tests for the analy-sis of whether the psychosocial factors were predictive of future time lost due to musculoskeletal injury were then assessed. Mann-Whitney U tests were implemented to analyze the difference in duration of time lost be-tween athletes that demonstrated psychosocial risk factors compared to those that did not.RESULTS: There were 49 musculoskeletal injuries, 14 traumatic (coded as fracture or sprain), 36 nontraumatic (coded as sprain or stress), with 2 re-peat injuries. There was not a significant difference between psychosocial scores (FABQ: P = .588; mean ± SD difference, 3.6 ± 3.96) (TSK: P = .366; mean difference, 2.18 ± 4.0; PCS: P = .18; mean difference, 5.25 ± 3.86) for college softball subjects who missed any time due to musculoskeletal injury. There was no association between psychosocial risk factors and days lost due to injury ((FABQ: r = 0.907, P = .341), (TSK: r = 0.337, P = .561), (PCS: r = 0.414, P = .520); however, subjects with higher scores on psychosocial questionnaires had longer duration of missed playing time (19.05 playing days) compared to athletes with lower scores (16.11 playing days), but this difference was not statistically significant (P>.05).CONCLUSIONS: Established psychosocial risk factors did not predict future playing time loss or duration of playing time lost due to musculoskeletal injury in Division I softball athletes.CLINICAL RELEVANCE: Prescreening athletes to identify psychosocial risk fac-tors may not add to prediction of missing playing time or amount of time lost following musculoskeletal injury. Furthermore, our results may not be applicable to other populations or conditions due to our narrow sam-ple and additional methods may be needed in this population aside from screening alone in predicting return to sport.

PURPOSE/HYPOTHESIS: Tendon mechanical properties have been previous-ly reported to predict [4] and relate to [7] function in individuals post Achilles tendon rupture. While these properties can be useful in devel-oping a prognosis and guiding treatment, expensive and invasive tech-niques limit translation into the clinic. Identifying clinical measures that could serve as surrogate measures of tendon mechanical proper-ties would provide valuable information to the physical therapist treat-ing these individuals.NUMBER OF SUBJECTS: Fourteen individuals within 1 year post–Achilles ten-don rupture.MATERIALS/METHODS: Fourteen individuals (mean ± SD age, 43.5 ± 15.2 years) after acute, unilateral Achilles tendon rupture were included in the study. The median (IQR) time since rupture was 3 (2-6) months with 10 subjects treated via surgical repair and 4 subjects treated nonsurgical-ly. Achilles tendon length to the gastrocnemius myotendinous junction was measured using B mode ultrasound imaging [5]. Tendon mechani-cal properties including shear modulus and viscosity were quantified us-ing continuous shear wave elastography (cSWE) [2,6]. Clinical outcomes included the Achilles tendon resting angle (ATRA) [1] and performance on the heel-rise test [3]. Participant self-reported activity level, function and symptoms were measured using the Physical Activity Scale (PAS) and Achilles tendon total rupture score (ATRS), respectively.RESULTS: Participants demonstrated elongation of the tendon on the rup-tured side, with a median (IQR) length of 22.2 (21.3-23.1) cm on ruptured and 21.2 (19.7-22.7) cm on nonruptured sides (P<.01). Viscosity was sig-nificantly less on the ruptured side, with a median (IQR) of 33.6 (29.3-42.5) Pa·s on rupture and 52.5 (46.4-62.4) Pa·s on nonrupture sides (P = .001). Shear modulus was not significantly different between sides, with a median (IQR) of 95.9 (72.5-106.7) kPa on rupture and 94.9 (91.0-101.1) kPa on nonrupture sides (P = .64). Participants performed less total work (P<.01), with less heel-rise height (P<.01) on the heel-rise test on the rup-tured side (n = 10). ATRA related both to shear modulus (η2 = 0.692, P<.01) and viscosity (η2 = 0.637, P<.05) on the ruptured side. Total work on the heel-rise test related to shear modulus (η2 = 0.642, P<.05) on the ruptured side (n = 10). Maximum heel-rise height was not related to shear modulus or viscosity (n = 10). Viscosity related to PAS score (η2 = 0.559, P<.05). Shear modulus related to both PAS (η2 = 0.581, P<.05) and ATRS scores (η2 = 0.609, P<.05).CONCLUSIONS: The results of this study indicate that mechanical properties are related to patient-reported activity level and self-reported function. Clinically, our results also support the use of ATRA and heel-rise test per-formance as surrogate measures for tendon mechanical properties in in-dividuals less than 1 year post–Achilles tendon rupture.CLINICAL RELEVANCE: Clinical tests, such as questionnaires, ATRA and the heel-rise test, can be used to indicate recovery of mechanical properties in a physical therapy setting.

OPO243THE RELATIONSHIP BETWEEN PSYCHOSOCIAL RISK FACTORS AND PLAYING TIME LOST DUE TO MUSCULOSKELETAL DYSFUNCTION IN DIVISION I COLLEGE SOFTBALL ATHLETES: A PILOT STUDY


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Orthopaedic Section Abstracts: Poster Presentations ......Poster Presentations OPO1-OPO243 The...

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