Background:CrossFit, a sport and fitness program, has become increasingly popular both nationally and internationally. Researchers have recently identified significant improvements in health and wellness due to CrossFit. However, some individuals assert that CrossFit poses an inherent risk of injury, specifically to the shoulder, due to the intensity of training. Currently, there is limited evidence to support this assertion.Hypothesis:Exercises performed during CrossFit do not place the shoulder at greater risk for injury. Injury rates are comparable to other sports of similar intensity.Study Design:Descriptive survey study.Level of Evidence:Level 5.Methods:An electronic survey was developed and dispersed to approximately 980 individuals who trained in CrossFit gyms. The survey identified demographic data, training characteristics, and the prevalence of injury over a 6-month period in individuals who participated in CrossFit training.Results:A total of 187 (19.1%) individuals completed the survey. Forty-four (23.5%) indicated that they had experienced a shoulder injury during CrossFit training over the previous 6 months. Of those who reported injury, 17 (38.6%) stated that this injury was an exacerbation of a previous injury sustained prior to starting CrossFit. There was no significant relationship between several demographic and training variables and shoulder injury. All shoulder injuries occurred at a rate of 1.94 per 1000 hours training, while “new” shoulder injuries occurred at a rate of 1.18 per 1000 hours training. The most commonly attributed causes of injury were improper form (33.3%) and exacerbation of a previous injury (33.3%). Twenty-five (64.1%) of those who experienced injury reported 1 month or less of training reduction due to the injury.Conclusion:Shoulder injury rates during CrossFit training are comparable to other methods of recreational exercise.Clinical Relevance:Clinicians should be aware of training demands of exercises in CrossFit and modifications for these exercises to safely progress their patients back to participation.

Background:Eccentric exercise is commonly used in the management of Achilles tendinopathy (AT) but its effectiveness for insertional AT has been questioned. Soft tissue treatment (Astym) combined with eccentric exercise could result in better outcomes than eccentric exercise alone.Hypothesis:Soft tissue treatment (Astym) plus eccentric exercise will be more effective than eccentric exercise alone for subjects with insertional AT.Study Design:Prospective randomized controlled trial.Level of Evidence:Level 2.Methods:Sixteen subjects were randomly assigned to either a soft tissue treatment (Astym) and eccentric exercise group or an eccentric exercise–only group. Intervention was completed over a 12-week period, with outcomes assessed at baseline, 4, 8, 12, 26, and 52 weeks. Outcomes included the Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A), the numeric pain rating scale (NPRS), and the global rating of change (GROC).Results:Significantly greater improvements on the VISA-A were noted in the soft tissue treatment (Astym) group over the 12-week intervention period, and these differences were maintained at the 26- and 52-week follow-ups. Both groups experienced a similar statistically significant improvement in pain over the short and long term. A significantly greater number of subjects in the soft tissue treatment (Astym) group achieved a successful outcome at 12 weeks.Conclusion:Soft tissue treatment (Astym) plus eccentric exercise was more effective than eccentric exercise only at improving function during both short- and long-term follow-up periods.Clinical Relevance:Soft tissue treatment (Astym) plus eccentric exercise appears to be a beneficial treatment program that clinicians should consider incorporating into the management of their patients with insertional AT.

Studies detailing the neurophysiological effects of spinal manual therapy have fueled a paradigm shift away from a strict biomechanical model. However, a recent systematic review of the temporal nature of a single session of spinal thrust manipulation found that the neurophysiological effects were only temporary. The objective of this review was to examine the temporal nature of neurophysiological effects after one session of spinal mobilization. Studies eligible for this review had to report on the temporal component of the neurophysiological effects of a single session of joint mobilization of the spine in human subjects. In order to be sure that the temporal nature of these effects was captured, the studies had to monitor neurophysiological effects for a time beyond the immediate post-treatment period. This systematic review followed the methodology for preferred reporting items for systematic reviews and meta-analyses. In order to assess the quality, strength, and importance of the included studies, the grading of recommendations assessment, development and evaluation system was used. Results of this review showed that the neurophysiological effects of a single session of spinal mobilization are mostly 5 minutes or less. An exception to these findings is hypoalgesia which may last up to 24 hours, based on one study. Continued research on small samples of healthy subjects with irrelevant immediate outcomes like salivary rate, skin conductance, and skin temperature should give way to randomized controlled trials on subjects with pain and decreased function.

It is possible to identify those patients who are at risk for an unsuccessful outcome through the use of variables such as body mass index, age, and sex.

Background and Purpose. Admission to a Doctor of Physical Therapy (DPT) program has traditionally required a determined cognitive level with less emphasis being placed on noncognitive attributes. It is now appreciated that many noncognitive factors such as coping self-efficacy, resilience, and emotional intelligence can factor into students' ability to successfully complete a graduate program that presents with increased workload and other demands that can invoke stress. To maximize success, students must be able to effectively cope with these stresses. The first purpose of this study was to determine if a cohort of students enter a DPT program with similar perceptions of their abilities to cope with stress. The second purpose was to determine if perceived coping abilities and specific coping strategies of this cohort changed over the first year of the program. Subjects. Physical therapy students enrolled in the first year of a 3-year DPT program at a Midwestern university were invited to participate. Of this cohort, 29 (60%) responded to the first survey, 23 (79%) of the initial participants completed the second survey, and 19 (65%) completed the third survey. Methods. An electronic survey was sent to these students at the beginning of their first, second, and third semesters. Students completed the survey anonymously. The Coping Self-Efficacy Scale (CSE) was used along with open-ended prompts about students' coping strategies and sources of stress. Repeated-measures analysis of variance (ANOVA) and post hoc paired t tests with Bonferroni correction were used to compare mean CSE scores between each semester. Qualitative content analysis of the responses from the open-ended questions was completed. Results. The mean CSE score from the initial survey was 6.35 (SD ± 0.32). Of the 26 questions in the CSE survey, 19 questions had a variance in score of eight points or more on a 10-point scale. There was a statistically significant difference between CSE scores over the three testing periods as determined by a repeated-measures ANOVA, F(2,50) = 79.19, P < .001). A Bonferroni post hoc test revealed that the differences between CSE scores occurred between all levels of testing (P < .001). Five themes describing active coping strategies and one theme of avoidance strategy emerged in the first round of data collection. In the second and third rounds of data collection, the avoidance strategy theme disappeared and only active strategies were mentioned. Discussion. The ability to cope with stress is an important factor affecting a student's success in an academic program. In this study, there was wide variability in students' perceived ability to cope with stress as determined from the CSE score when entering a DPT program. Statistically significant increases in CSE scores over each subsequent semester indicated improved confidence in coping ability after succeeding despite stressful situations typical of the first year of a DPT program. Qualitative themes from open-ended prompts about coping strategies also supported this conclusion. Findings suggest that planned intervention on the part of academic faculty to further facilitate this growth in coping ability should be considered to increase student success.

Study design: Systematic literature review and meta-analysis. Objective: In symptomatic subjects to: (1) examine the effects of a single session of joint mobilization on pain at rest and with most painful movement, and (2) compare the effects when joint mobilization is provided to a specific or non-specific spinal level. Background: Joint mobilization is routinely used for treating spinal pain in conjunction with other interventions, but its unique effect is not well understood. Further, there is controversy about the role of 'specific level' techniques in producing benefit. Methods: Searches were performed for randomized controlled trials (RCTs) using electronic databases (MEDLINE, CINAHL, and PEDro) from 1966 through November 2010. Methodological quality was assessed using previously detailed criteria. Meta-analysis and meta-regression were conducted on eligible studies. Results: Eight RCTs with a mean methodological score of 10/12 were included. Significant heterogeneity (P50.075) was found in the overall meta-analysis estimate. When stratified by body location, no significant individual effect was found for pain at rest. However, there was a statistical mean difference [0.71 (95% confidence interval: 0.13-1.28)] between pain at rest for the cervical and lumbar individual means. Conclusions: We found multiple studies which provided evidence that a single session of joint mobilization can lead to a reduction of pain at rest and with most painful movement. When using joint mobilization, the need for specific versus non-specific level mobilization may be influenced by anatomical region; the direction of effect in the cervical spine was toward specific mobilization and in the lumbar spine towards non-specific mobilization.

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYMH treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.

Findings suggest that various outcome measures for the ankle capture different dimensions and should be considered when evaluating the presence of disability or long-term change in outcome.