Background: Strengthening and activation of the gluteus maximus and gluteus medius while minimizing the contribution of the tensor fascia latae are important components in the treatment of many lower limb injuries. Previous researchers have evaluated a myriad of exercises that activate the gluteus maximus (GMax) and gluteus medius (GMed), however, limited research has been performed describing the role of the addition of elastic resistance to commonly used exercises. Purpose: The primary purpose of this study was to determine the gluteal-to-tensor fascia latae muscle activation (GTA index) and compare electromyographic muscle activation of the GMax, GMed, and TFL while performing 13 commonly prescribed exercises designed to target the GMax and GMed. The secondary purpose of this study was to compare muscle activation of the GMax, GMed, and TFL while performing a subgroup of three matched exercises with and without elastic resistance. Study Design: Repeated measures cohort study Methods: A sample of 11 healthy, physically active male and females, free of low back pain and lower extremity injuries, were recruited for the study. Surface electromyography was used to quantify the normalized EMG activation of the gluteus maximus, gluteus medius, and tensor fascia latae while performing 13 exercises. Three of these exercises were performed with and without elastic resistance. The maximal voluntary isometric contraction was established for each muscle and order in which the exercises were performed was randomized to minimize the effect of fatigue. Results: The relative activation of the gluteal muscles were compared to the tensor fascia latae and expressed as the GTA index. Clams with and without resistance, running man gluteus maximus exercise on the stability trainer, and bridge with resistance, generated the highest GTA index respectively. Significant differences in activation of the TFL occurred between clams with and without resistance. Conclusions: The findings are consistent with those of previous investigators who reported that the clam exercise optimally activated the gluteal muscles while minimizing tensor fascia latae activation.

A variety of cognitive assessment tools are used to determine the functional status of the brain before and after injury in athletes. Questionnaires, neuropsychological tests, and electroencephalographic (EEG) measures have been recently used to directly assess brain function on and near the playing field. However, exercise can affect cognitive performance and EEG measures of cortical activity. To date, little empirical evidence exists on the effects of acute exercise on these measures of neurological function. We therefore quantified athlete performance on a standardized battery of concussion assessment tools and EEG measurements immediately before and after acute exercise to simulate conditions of athletic competition. Heart rate and arterial oxygen levels were collected before and after the exercise challenge consisting of a 1-mile run. Together these data, from a gender-balanced cohort of collegiate athletes, demonstrated that moderate to hard levels of acute exercise improved performance on the King-Devick test (K-D test) and Standardized Assessment of Concussion (SAC) component of the Sport Concussion Assessment Tool (SCAT3). Gender played an important role in these effects, and performance was most affected by exercise in female athletes. EEG activity in the theta band (4–8 Hz) was decreased during periods of quiet resting with eyes open or eyes closed. Additionally, exercise produced a slowing of the EEG during the K-D test and a shift to higher frequencies during the balance assessment of the SCAT3. Together, these data indicate that exercise alone can influence outcome measures of cognitive assessment tools used to assess brain function in athletes. Finally, care must be taken to acquire postinjury measurements during a comparable physiologic state to that in which baseline assessment data were measured, and further research is needed into the factors influencing outcome measures of these tests.

Background Adherence to prescribed medical interventions can predict the efficacy of the treatment. In physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps, have been introduced for patients to increase their adherence to attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending chiropractic and rehabilitation clinic visits. Objective This study aims to compare adherence to prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. Methods The medical records of new patients who presented for care during 2019 and 2020 at 5 community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and to determine whether the patient was provider-discharged or self-discharged. During this 24-month study, 36.28% (1497/4126) of patients seen in the targeted clinics had downloaded the Kanvas app on their mobile phone, whereas the remaining patients chose not to download the app (usual care group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits, which could be redeemed as an incentive. Results During both 2019 and 2020, the Kanvas app group was provider-discharged at a greater rate than the usual care group. The Kanvas app group kept a similar number of appointments compared with the usual care group in 2019 but kept significantly more appointments than the usual care group in 2020. During 2019, both groups exhibited a similar number of no-show appointments; however, in 2020, the Kanvas app group demonstrated more no-show appointments than the usual care group. When collapsed across years and self-discharged, the Kanvas app group had a greater number of kept appointments compared with the usual care group. When provider-discharged, both groups exhibited a similar number of kept appointments. The Kanvas app group and the usual care group were similar in the number of no-show appointments when provider-discharged, and when self-discharged, the Kanvas app group had more no-show appointments compared with the usual care group. Conclusions Patients who did or did not have access to the Kanvas app and were provider-discharged exhibited a similar number of kept appointments and no-show appointments. When patients were self-discharged and received the Kanvas app, they exhibited 3.2 more kept appointments and 0.94 more no-show appointments than the self-discharged usual care group.

Background: Annually, $30%-50% of adults will experience some form of debilitating neck pain. One approach to treating neck pain is cervical manipulation. This treatment modality has, at times, been reported to result in a short-term increase in pain, which in turn has been linked to reduced neck range of motion (ROM). Elastic therapeutic tape (ETT) has been shown to reduce musculoskeletal pain, although limited research has been conducted to determine if ETT can mitigate pain and facilitate neck ROM following cervical manipulation. Purpose: The purpose of this study is to compare the pain and neck ROM among patients with acute neck pain who do and do not receive ETT following cervical manipulation. Methods: A convenience sample of 50 patients between 18 and 64 years of age presented with acute noncomplicated neck pain was recruited from an outpatient chiropractic clinic. Patients were randomly assigned to 2 groups. In the tape group (n = 27), ETT was applied to their neck immediately following cervical manipulation for neck pain. In the control group (n = 23), cervical manipulation was performed with no application of ETT following the procedure. Pain and neck ROM were recorded at the following 3 different intervals: pre-cervical manipulation (T1), within 5 minutes of cervical manipulation (T2), and 24-48 hours after manipulation (T3). In total, 6 cervical ROM values were recorded with dual inclinometers. Pain was measured by asking of each patient to rate their neck pain using the numeric pain rating scale from 0 to 10. Results: The tape group demonstrated a significant decline (P < 0.00) in pain between T1 (x = 6.15) and T2 (x = 5.37) and between T1 and T3 (x = 4.89). The control group did not report significant changes in their pain over the duration of the study. Neither group reported any significant change in any measure of neck ROM over the duration of the study. Clinical Relevance: Results from this study support the use of ETT to reduce pain immediately and 24-48 hours following cervical manipulation among patients presenting with acute neck pain.

Purpose: The purpose of this study is to determine whether patients with mechanical neck pain who received topical menthol gel application to their neck before cervical manipulation experienced a reduction in pain and an increase in neck range of motion following cervical manipulation. Methods: Patients (mean age, 35 years) with nonradicular mechanical neck pain were randomly assigned to a control (n = 31) or a treatment (n = 29) group. Five minutes before cervical manipulation, controls received topical placebo gel application to their neck, whereas the treatment received topical application of a mentholcontaining gel (Biofreeze ® ). Participants rated their neck pain on a 10-point scale before application of the get (Pre) and at 1 min (T1), 10 min (T2), 20 min (T3), and 30 min (T4) after cervical manipulation. Six measures of neck range of motion were assessed before the topical applications of gel and at T1 and T4. Repeatedmeasures ANCOVA was performed to compare the pain and neck range of motion following manipulation while controlling for premeasures. Results: There were no significant differences between the groups' pain or range of motion assessed at Pre. The treatment group reported significantly (P < .05) reduced pain at T2, T3, T4 compared to T1, while the control group did not experience significant change in their pain compared to T1. Neither study group rated a change in neck range of motion during the study. Conclusion: Topical menthol application before manipulation may reduce neck pain, but it has no measurable effect on neck range of motion following cervical manipulation among patients with mechanical neck pain.Keywords: Neck pain; manipulation; topical menthol Key Points After cervical manipulation, topical menthol (Biofreeze) applied to the neck reduced post-manipulation soreness in patients with mechanical neck pain, but it did not change the cervical range of motion.

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BACKGROUND Adhering to prescribed medical interventions predicts the efficacy of the treatment. In the physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps have been introduced with patients to increase their adherence with attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending a chiropractic and rehabilitation clinic visits. OBJECTIVE The purpose of this study was to compare adherence with prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS The medical records of new patients who presented for care during 2019 and 2020 at five community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and if the patient was provider discharged or self-discharged. During this 24-month study 36.3% of the 4,126 patients seen in the targeted clinics had downloaded the Kanvas App to their mobile phone while the remaining patients chose not to download the app (Usual Care Group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits which could be redeemed for an incentive. RESULTS During both 2019 and 2020 respectively the Kanvas App Group (50%-38%) were provider discharged at a greater rate than the Usual-Care group (47-31%). The Kanvas App Group kept a similar number of appointments compared to the Usual-Care Group in 2019 (10.20 vs. 8.68) but kept significantly more appointments than the Usual-Care Group in 2020 (11.63 vs. 7.67). During 2019 both groups exhibited a similar number of no-show appointments (1.89 vs 1.96) but in 2020 the Kanvas App Group demonstrated more no-show appointments (2.89 vs 2.14) than the Usual Care. When collapsed across years and self discharged the Kanvas App group had a greater number of kept appointments (7.79) compared to the Usual Care group (4.58). When provider discharged both groups exhibited a similar number of kept appointments (15.25 vs 13.82). The Kanvas App group (1.38) and the Usual Care group (1.34) were similar in the number of no-show appointments when provider discharged and when self-discharged the Kanvas App Group had more no-show appointments (3.37) compared to the Usual Care Group (2.44). CONCLUSIONS When patients were provider discharged, they exhibited a similar number of kept appointments and no-show appointment. When subjects were self-discharged and received the Kanvas App they exhibited 3.2 more kept appointments and .94 more no-show appointments than self-discharged Usual Care group.

BackgroundEffective non-opioid pain management is of great clinical importance. The objective of this pilot study was to evaluate the effectiveness of multimodal mechanical stimulation therapy on low back pain.Methods11 female and 9 male patients aged 22–74 years (Mean 41.9 years, SD 11.04) receiving physical rehabilitation for acute (12) or chronic (8) low back pain chose heat (9) or ice (11) to accompany a 20-minute session of mechanical stimulation (M-Stim) therapy (Registered with Clinicaltrials.gov NCT04494841.) The M-Stim was delivered in 12 possible repeating “therapy cycle” patterns by three vibration motors (50 Hz, 100 Hz, 200 Hz) with amplitudes between 0.1–0.3 m/s2. Ten patients used a contained motor chassis attached to a thermoconductive single-curve metal plate. The next 10 patients' device had motors attached directly to a multidimensionally curved plate.ResultsMean pain on a 10 cm Visual Analog Scale (VAS) with the first motor/plate configuration went from 4.9 ± 2.3 cm to 2.5 ± 2.1 cm (57% decrease, p = 0.0112), while the second reduced pain from 4.8 ± 2.0 cm to 3.2 ± 1.9 cm (45%, p = 0.0353). Initial pain was greater with acute injury (5.8 ± 2.0 cm vs. 3.98 ± 1.8, p = 0.025) and for patients older than 40 (5.44 vs. 4.52), but pain reduction was proportional for chronic and younger patients. There was no significant difference between plate configurations.ConclusionsA Phase I clinical pilot investigation on a multi-motor multi-modal device was promising for drug free pain relief. Results suggested pain relief independent of thermal modality, patient age, or pain chronicity. Future research should investigate pain reduction over time for acute and chronic pain.Clinical Trial Registrationhttps://ClinicalTrials.gov, identifier: NCT04494841.