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Research Articles

At Symmetry Physical Therapy, Downtown Miami/Brickell, our therapists formulate treatment programs on the most up to date and recent research. Check out some interesting physical therapy research summaries below. Want to learn more? Click on the physical therapy research article title for the full read.

Functional Movement Screen (FMS)

The functional movement screen is a tool used to evaluate movement quality and patterns in athletes and clinicians. The screen is not intended to identify orthopedic conditions but instead to identify limitations in movement and asymmetries that may increase risk of injury. This can then help guide treatment and exercise prescription. The test consists of seven movements that measure a balance of mobility and stability. Each movement is scored on a 0-3 scale depending on how correctly the movement was performed and totaled at the end. The movements consist of a deep squat test, hurdle step, in-line lunge, active straight leg raise, shoulder mobility, trunk stability push up, and rotatory stability.

As an athlete injuries can be a big setback. Therefore, finding ways to prevent injuries is very important. Research has identified the importance of agonist/antagonist muscle ratios, structural abnormalities, gender, pre-training fitness level, and prior history of injury as factors for injuries. The Functional Movement Screen (FMS) was created and developed by Gray Cook to assist with identifying an increased risk of injury. This screen consists of 7 movement test that can be quickly performed to identify restrictions or alterations in normal movement. A score from 0-3 is given for each movement and totaled at the end giving a score from 0-21. In this study authors looked to see if FMS score correlated with an injury risk in 38 NCAA division II female collage athletes. Following the study it was determined that a score of 14/21 or less was associated with a 69% increased risk of lower extremity injury in female collegiate athletes participating in fall and winter sports. Therefore, it appears that the FMS can be a helpful tool in predicting injury risk in female athletes.

Professional football is a very intense sport that can commonly lead to injury. Little data exists regarding risk factors that could predispose football players to injury. Generally, it is believed that athletes with poor dynamic balance or asymmetrical strength and flexibility are more likely to be injured. The Functional Movement Screen discussed in detail here is a movement screen that was designed to assess for asymmetries and poor dynamic balance, therefore making it a potential screen for injury prevention. The authors of this study looked to see if a poor score on the FMS was a predictor of potential injury. One professional football team of 46 players completed the test prior to the start of the season. Upon analysis of the data it was determined that a score of 14 or less on the FMS was a positive predictor of serious injury. This demonstrates that players with dysfunctional fundamental movement patterns as measured by the FMS are greater increased risk for injury than those scoring higher on the FMS.

The firefighter profession is very intense and physically demanding. Injuries happen all the time while training or on an actual mission. This can be very dangerous given the magnitude of the situation, so preventing injuries is very important for this population. In this study, the authors looked to see if any common measures in movement could be identified to predict future injury. The authors used the functional movement screen, further explained here and physical performance measures such as sit and reach, pushup test, pull up test, 1.5-mile run, and the tower test. Following analysis of the data for 108 firefighters it was determined that an FMS score of 14 or less as well as a poor sit and reach test were predictors of possible injury. Therefore, preventing injuries in firefighters can be helped by taking into account basic movement patterns and training according to what was found.


With the increase in sedentary life styles the number of postural dysfunctions has increased significantly. One of the more prevalent is termed Upper Cross Syndrome (UCS). This is characterized by over active pectoral and upper trapezius muscles and under active lower and middle trapezius muscles. This causes what is seen as a forward head position, rounded shoulders, and winging of the scapula. In Physical Therapy, this is a common dysfunction that is seen and treated by stretching and mobilization the muscles that are tight and strengthening the muscles that are weak. In this study, the authors looked to see if applying kinesiotape (further explained here) to the upper and lower trapezius would decrease and increase muscle activity respectively. KT tape was applied to 20 individuals and sEMG testing was completed with the tape on and 24 hours after the tape was removed. The authors found that using the tape was able to inhibit the active muscle the upper trapezius and facilitate the inhibit muscle the lower trapezius. Therefore, incorporating KT into the treatment plan for patients with UCS maybe valuable tool to fully recovery.

Shoulder pain is very common musculoskeletal complaint. Epidemiologists have suggested that life time prevalence of shoulder pain ranges from 7 to 36 percent. The vast majority of shoulder injuries are treated conservatively through Physical Therapy first. Identifying what treatments have an impact on outcomes is very important. This study looked to see if kinesiotape (KT) is an effective treatment for shoulder pain. Kinesiotape involves the application of an elastic tape that has the ability to stretch. This tape is said to have effects of inhibiting muscles spasms, assisting with postural correcting, decreasing pain, and facilitating inactive muscles. For more information on KT visit here. After analyzing 42 individuals in 2 groups the authors determined that KT may be of some assistance to improve pain-free active ROM in individuals with shoulder pain. In other words application of KT to the shoulder may allow for more shoulder motion without pain.
or increased pain free shoulder ROM.

Y Balance Testing Information

The Y balance test is a screen for dynamic balance that requires stance leg balance while the other leg reaches forward, back, and sideways. This test has been proposed as a predictor of injury but has not been tested. The authors of this studied assessed 184 D1 college athletes prior to the start of their season on the Y balance test. Results demonstrated that an asymmetry of greater than 4 cm for the forward direction was significantly associated with a noncontact injury. Therefore, if looking to prevent injury or return to sport the Y balance test maybe a valuable tool to allow you to stay healthy.

Previous studies have hinted on the possibility that individuals with poor dynamic balance are at an elevated risk of injury. The star excursion balance test (SEBT) is a test that assist in measuring dynamic balance by having individuals stand in a circle and reach with the opposite leg as far as possible. This is then compared right versus left. Hypothetically the authors presumed that asymmetries in the test increase the risk for noncontact related injuries. Fifty-nine college football athletes were assessed at the start of the season. Following analysis of the data it was determined that a score below 89.6% was at an increased risk of sustaining a non-contact lower extremity injury. Therefore, this can be a valuable tool in the prevention of injury as well as returning to sport.

Sitting Induced Neck and Back Pain

Neck pain is a major problem in modern society with the increase in sedentary life styles. The prevalence of neck pain in one year has been recorded at 29% and 40% for men and women respectively. With percentages that high identifying what factors may be causing neck pain can be very beneficial. In this study the authors completed a systemic analysis of current studies to see if any clear factors could be identified. Results demonstrated a positive relationship between neck flexion, arm force, arm posture, duration of sitting, twisting or bending trunk, hand-arm vibration, and workplace design. This information is can very valuable to correctly assess and treat any factors that may be causing neck pain as well as prevent neck pain.

Research has shown that sitting for a prolonged period of time can lead to neck pain. Therefore, understanding how to counteract the effects of sitting is very important to stopping and avoid it. This is even more important as society continues to evolve into a sedentary way of life. The authors of this article looked to see what exercises can be helpful to improve sitting posture in individuals with neck pain. 58 subjects were randomized into a control group and two groups one performing craniocervical flexor training and the other endurance/strength training of cervical flexor muscles. The crainocervical flexor training group performed basic head nods using a biofeedback cuff while the endurance/strength training cervical flexor group performed larger head movements with resistance. To determine the results the authors measured the cervical angle position (head position) of the subjects at work during 2 and 10-minute intervals. Conclusion of the study determined that crainocervical flexor training allowed the individuals to maintain a better head position for longer periods of time that any of the other groups. Basically, including crainocervical flexion exercises into a routine can significant improve head position during sitting.

Myofascial pain syndrome is defined as a regional pain syndrome associated with pain and trigger points. A trigger point is believed to be an area of a muscle in spasm and a subsequent block of blood circulation that can usually be detected by a taut muscle band. Trigger points are thought to be related to poor postures, neuromusculoskeletal disorders, chronic minor muscle strains, bursitis, arthritis or disc lesions. Myofascial pain syndrome commonly presents as local pain in the muscle, a taut band of muscle, and or limitations in ROM. Traditional treatments consist of stretching, heat, massage, manipulation, electrical stimulation, trigger point injections, acupuncture, and medicine, however sometimes these methods are not effective. The authors of this studied looked to see if Kinesio tape (KT), further explained here, could be an effective method of treatment for this condition. KT has been demonstrated via ultrasound to have effects of improving blood circulation and lymph fluid drainage as it elevates the subcutaneous space. This has significant implications for trigger point treatment as it may due to a blockage of blood supply. Therefore, traditional methods may benefit from the inclusion of KT as a treatment tool.

Low back pain can be a very debilitating condition. An initial episode of acute low back pain is said to spontaneously resolve through its natural course of history, however many times recurrent episodes can occur or even worse the development of chronic pain. Studies have noticed a lack of lower back muscle firing, specifically in the multifidus muscles as a possible cause for this recurrence of low back pain as it does not fully return to function following an acute incident. Therefore, the authors of this studied looked to determine if specific exercises targeted at restoring function of the multifidus muscle could prevent recurrence of low back pain. Thirty-nine individuals were separated into two groups, a control, and an exercise group. Following the program and conclusion of assessments at one and three year marks it was determined that completing exercises targeted at restoring multifidus function decreased recurrence rates from 84% to 30% at one year and 75% to 35% at three years. Therefore, completing specific back rehabilitation exercises can help prevent a recurrence of low back pain.

Neck pain is a major health issue in modern society. Studies have shown that roughly 4 out of 10 people suffer from neck pain in a year. Identifying what contributes to neck pain is crucially important to stopping it. Currently neck pain has been identified as multi-factorial. In other words, having multiple causes. The authors of this studied looked to see if sitting for a long time is one of those causes. After analyzing 1334 workers from 34 companies for 3 years it was concluded that sitting at work for more than 95% of the time is a risk factor for neck pain. There also appears to be a link between neck pain and neck flexion (rounded) position during work. So what does this mean in terms of practical advice? First, try to limit the amount of time spent sitting by getting and up and moving often. Second, if you are sitting down make sure to position yourself in the best possible posture to reduce the amount the neck has to work.

Prolonged sitting has always been proposed a mechanism for low back pain. With low back pain rates on the rise determining how and what the mechanism is can be very valuable. In this study authors looked to see the difference in trunk muscle activation in patients with low back pain and those with no back pain. Thirty-four pain free and thirty three nonspecific chronic low back pain patients were recruited. Muscle activation was measured using a sEMG to see what muscles were firing and compare the groups. The low back pain patients were classified into two groups, active extension and flexion pattern depending on how they were sitting. On comparison of the active extension and flexion groups the authors found higher levels of multifidus, illiocostalis, obliques contraction in the active extension group versus the flexion group. This can help treating clinicians to identify which muscles are being over contracted and under contracted thus helping guide treatment.

How important is it to start Physical Therapy right after injuring your back? The authors of this article took on the role of trying to answer this question. Two hundred and twenty individuals were put into two groups, early Physical Therapy and usual care. Results were measured using the Owestry disability index, which is a series of questions that measures your current disability level. This assessment was completed at 3 months, 6 months, and 1 year. Following the analysis of the information a statistically significant improvement in disability for the group that received early Physical Therapy was seen. So what does this mean for you? The sooner you can get in and start seeing a Physical Therapist for your acute low back pain the faster you can recover and get back to living the lifestyle you want!

Neck pain can be a very debilitation condition that can keep you down. In this article the authors conducted a case study that examined the effects of a specific exercise program and modification of postural alignment in a patient with cervicogenic headaches. The patient had a 7-year history of headaches that increased with activities that got worse when using his hands and sitting for a long time. Treatment consisted of exercises to address neck, shoulder, and low back muscle imbalances and postural corrections for sitting position. After 7 treatments improvements were seen in pain and ability to complete daily activities. To summarize addressing posture and improving muscle balances can a play critical component to a successful recovery from cervicogenic headache. So next time you get a headache that is muscular related come in and see a Physical Therapist to get on the path of recovery.

Additional Articles

Injuries in baseball are a very common occurrence. Identifying potential injury risk factors can be of tremendous importance to staying healthy and playing the sport. These injuries are commonly believed to be caused by limitations in shoulder and hip range of motion, alterations of lumbo-pelvic movements, decreased balance, and poor foot postures. Pitching a baseball can be broken down into different phases of the movement to help understand the most optimal body mechanics. Researchers have shown that excessive foot pronation (collapsed arch) during the foot down portion of pitching has been associated with increased injury. Therefore, incorporating specific endurance and strength training exercises to correct these faults can be valuable to decreasing injury. The authors suggest performing exercises such as towel curls, side bridging, single leg squats, hip hiking, and single leg deadlifts to help strengthen and build endurance.

The glutes sometimes called the powerhouse of the body help use walk, squat, run, and jump. These powerhouse muscles include the well-known glute maximus, and the lesser known but equally important glute mediues and minimus. The glute maximus is a powerful hip extender commonly fired during squatting and jumping. The glute mediues and minimus are involved in more rotational movements, hip abduction (taking the leg away from the midline), and keeping the pelvis level during walking and running. Excellent exercises to help strengthen the glutes are hip extension in all fours, side lying hip abduction, single leg bridge, sidewalks with resistance band, and clamshells.

Patellofemoral pain syndrome (PFPS) is one of the most common knee conditions seen in the clinic. Many different types of treatment techniques exist. Some can be very beneficial while others do not help at all. The authors of this study used an evidence based approach to analyze the current research to see what really makes a difference. Searching through 10 years of studies pertaining to PFPS the authors determined that general quadriceps and hip strengthening shows the most promise. While interventions such as patellar taping, patellar bracing, knee bracing, and foot orthosis demonstrated inconclusive results. So what does this mean for you? If you have been diagnosed with PFPS the best evidence based treatment consists of a personally tailored program that places greatest emphasis on quadriceps and hip strengthening! So get in to see your Physical Therapist who can make an evidence based selection on what strengthening exercises you should be doing to correct your knee pain.