Acute Effects and Perceptions of Deep Oscillation Therapy for Improving Hamstring Flexibility

Context:Hamstring inflexibility is typically treated using therapeutic massage, stretching, and soft tissue mobilization. An alternative intervention is deep oscillation therapy (DOT). Currently, there is a lack of evidence to support DOT’s effectiveness to improve flexibility.Objective:To explore the effectiveness of DOT to improve hamstring flexibility.Design:Randomized single-cohort design.Setting:Research laboratory.Participants:Twenty-nine healthy, physically active individuals (self-reported activity of a minimum 200 min/wk).Interventions:All participants received a single session of DOT with randomization of the participant’s leg for the intervention. The DOT intervention parameters included a 1∶1 mode and 70% to 80% dosage at various frequencies for 28 minutes. Hamstring flexibility was assessed using passive straight leg raise for hip flexion using a digital inclinometer. Patient-reported outcomes were evaluated using the Copenhagen Hip and Groin Outcome Score and the Global Rating of Change (GRoC).Main Outcome Measure:The independent variable was time (pre and post). The dependent variables included passive straight leg raise, the GRoC, and the participant’s perceptions of the intervention. Statistical analyses included a dependentttest and a Pearson correlation.Results:Participants reported no issues with sport, activities of daily living, or quality of life prior to beginning the intervention study on the Copenhagen Hip and Groin Outcome Score. Passive straight leg raise significantly improved post-DOT (95% confidence interval, 4.48°–7.85°,P < .001) with a mean difference of 6.17 ± 4.42° (pre-DOT = 75.43 ± 21.82° and post-DOT = 81.60 ± 23.17°). A significant moderate positive correlation was identified (r = .439,P = .02) among all participants between the GRoC and the mean change score of hamstring flexibility. Participants believed that the intervention improved their hamstring flexibility (5.41 ± 1.02 points) and was relaxing (6.21 ± 0.86).Conclusions:DOT is an effective intervention to increase hamstring flexibility.

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Patient reported outcomes in a large cohort of patients receiving osteopathic care in the United Kingdom

PLoS ONE ◽

10.1371/journal.pone.0249719 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249719

Author(s):

Carol Fawkes ◽

Dawn Carnes

Keyword(s):

Patient Reported Outcome Measures ◽

Change Score ◽

Patient Reported Outcome ◽

Mobile App ◽

Standards Of Care ◽

Common Symptom ◽

Global Rating ◽

Bournemouth Questionnaire ◽

Patient Reported ◽

Prospective Study Design

Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app. Methods A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients’ satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment. Results A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% of patients reported they’d had their symptoms for 13 weeks or more. Low back pain was the most common symptom (55.8%). Patients reported high scores for both satisfaction and experience of osteopathic care: 88.1% were very satisfied at six weeks post-baseline and 93.5% reported very good experience at six weeks post-baseline. Data from the Global Rating of Change scale indicated that at one week post-baseline 89.1% of patients reported some measure of improvement, and at six weeks this figure rose to 92.8%. The mean sum score for the Bournemouth Questionnaire went from 30.8 at baseline to 13.3 at six weeks post-baseline. This represented a significant and clinically meaningful positive change score of 56.8%. Conclusion The app was well-completed and the data very encouraging. These data will help to form the basis for standards of care for patients attending osteopathic practices.

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Acute Lower Extremity Running Kinematics After a Hamstring Stretch

Journal of Athletic Training ◽

10.4085/1062-6050-47.1.5 ◽

2012 ◽

Vol 47 (1) ◽

pp. 5-14 ◽

Cited By ~ 4

Author(s):

Autumn L. Davis Hammonds ◽

Kevin G. Laudner ◽

Steve McCaw ◽

Todd A. McLoda

Keyword(s):

Pelvic Tilt ◽

Knee Extension ◽

Swing Phase ◽

Treadmill Running ◽

Control Group ◽

Single Session ◽

Anterior Pelvic Tilt ◽

Hamstring Flexibility ◽

Hip Flexion ◽

Straight Leg Raise

Context: Limited passive hamstring flexibility might affect kinematics, performance, and injury risk during running. Pre-activity static straight-leg raise stretching often is used to gain passive hamstring flexibility. Objective: To investigate the acute effects of a single session of passive hamstring stretching on pelvic, hip, and knee kinematics during the swing phase of running. Design: Randomized controlled clinical trial. Setting: Biomechanics research laboratory. Patients or Other Participants: Thirty-four male (age = 21.2 ± 1.4 years) and female (age = 21.3±2.0 years) recreational athletes. Intervention(s): Participants performed treadmill running pretests and posttests at 70% of their age-predicted maximum heart rate. Pelvis, hip, and knee joint angles during the swing phase of 5 consecutive gait cycles were collected using a motion analysis system. Right and left hamstrings of the intervention group participants were passively stretched 3 times for 30 seconds in random order immediately after the pretest. Control group participants performed no stretching or movement between running sessions. Main Outcome Measure(s): Six 2-way analyses of variance to determine joint angle differences between groups at maximum hip flexion and maximum knee extension with an α level of .008. Results: Flexibility increased between pretest and post-test in all participants (F1,30 = 80.61, P<.001). Anterior pelvic tilt (F1,30 = 0.73, P=.40), hip flexion (F1,30 = 2.44, P=.13), and knee extension (F1,30 = 0.06, P=.80) at maximum hip flexion were similar between groups throughout testing. Anterior pelvic tilt (F1,30 = 0.69, P=.41), hip flexion (F1,30 = 0.23, P=.64), and knee extension (F1,30 = 3.38, P=.62) at maximum knee extension were similar between groups throughout testing. Men demonstrated greater anterior pelvic tilt than women at maximum knee extension (F1,30 = 13.62, P=.001). Conclusions: A single session of 3 straight-leg raise hamstring stretches did not change pelvis, hip, or knee running kinematics.

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Effects of Static and Hold-Relax Stretching on Hamstring Range of Motion Using the FlexAbility LE1000

Journal of Sport Rehabilitation ◽

10.1123/jsr.8.3.195 ◽

1999 ◽

Vol 8 (3) ◽

pp. 195-208 ◽

Cited By ~ 19

Author(s):

Phillip A. Gribble ◽

Kevin M. Guskiewicz ◽

William E. Prentice ◽

Edgar W. Shields

Keyword(s):

Range Of Motion ◽

Measurement Technique ◽

Training Group ◽

Knee Extension ◽

Hamstring Flexibility ◽

Hip Flexion ◽

Straight Leg Raise

The purposes of this study were to determine the effects of static and hold-relax stretching on hamstring range of motion and to examine the reliability of the FlexAbility LE1000 compared with the goniometrically measured active knee-extension test. Forty-two participants (18–25 years old) were assigned to either a control, static, or hold-relax training group. Participants were stretched four times a week over a 6-week period, with four 30-s stretches per session using a straight-leg-raise method on the FlexAbility LE1000. It was determined that both static and hold-relax techniques significantly improved hamstring flexibility (ISLR: +33.08° ± 9.08° and +35.17° ± 10.39°, respectively). Participants of both techniques reached a plateau in flexibility improvement between Weeks 4 and 5. Thus, static and hold-relax stretching are equally effective in improving hamstring ROM. The FlexAbility LE1000 and the goniometer were both found to be highly reliable. Therefore, either measurement technique could be used successfully to measure hip-flexion ROM.

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Cross-cultural translation and validation of the Spanish version of the patellofemoral pain and osteoarthritis subscale of the KOOS (KOOS-PF)

BMC Research Notes ◽

10.1186/s13104-021-05619-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Juan Pablo Martinez-Cano ◽

Daniel Vernaza-Obando ◽

Julián Chica ◽

Andrés Mauricio Castro

Keyword(s):

Intraclass Correlation ◽

Patellofemoral Pain ◽

Spanish Version ◽

Minimal Detectable Change ◽

Global Rating ◽

Minimal Important Change ◽

Specific Patient ◽

Retest Reliability ◽

Patient Reported ◽

Test Retest Reliability

Abstract Objective The aim of this study was to translate to Spanish the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF) and validate this Spanish version of a disease-specific patient-reported outcome measure (PROM) for patellofemoral pain. Results The KOOS-PF was translated to Spanish and sixty patients with patellofemoral pain and/or osteoarthritis accepted to complete the questionnaire. 1-week later 58 patients answered the questions again for the test–retest reliability validation and finally 55 patients completed 1-month later for the responsiveness assessment. The Spanish version showed very good internal consistency (Cronbach’s alpha: 0.93) and test–retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, showing a strong correlation with the global rating of change (GROC) score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.

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POS1418 REALIZING EARLY RECOGNITION OF ARTHRITIS IN TIMES OF INCREASED TELEMEDICINE: THE VALUE OF PATIENT-REPORTED SWOLLEN JOINTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.235 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 992.1-992

Author(s):

C. Rogier ◽

B. Van Dijk ◽

E. Brouwer ◽

P. De Jong ◽

A. Van der Helm - van Mil

Keyword(s):

Early Recognition ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Self Report ◽

Symptom Duration ◽

Likelihood Ratios ◽

Predictive Values ◽

Patient Level ◽

Patient Reported ◽

Joint Examination

Background:Early diagnosis and management of patients with inflammatory arthritis(IA) are critical to improve long-term patient-outcomes. Assessment of joint swelling at joint examination is the reference of IA-identification; early access clinics are constructed to promote this early recognition of IA. However, due to the COVID-19 pandemic the face-to-face capacity of such services is severely reduced. The accuracy of patient-reported swelling in comparison to joint examination has been extensively evaluated in established RA (ρ 0.31-0.67), but not in patients suspected for IA.[1]Objectives:To promote evidence based care in the era of telemedicine, we determined the accuracy of patient-reported joint swelling for actual presence of IA in persons suspected of IA by general practitioners(GP).Methods:Data from two Dutch Early Arthritis Recognition Clinics were studied. These are screening clinics (1.5-lines-setting) where GPs send patients in case of doubt on IA. At this clinic patients were asked to mark the presence of swollen joints on a mannequin with 52 joints. For this study the DIP joints and the metatarsal joints were excluded and, therefore, a total of 42 joints were assessed for self-reported joint swelling. Clinically apparent IA of ≥1 joint determined by the physician was the reference to calculate sensitivity, specificity, positive and negative likelihood ratios (LR+,LR-), and positive and negative predictive values (PPV, NPV) on patient-level. Pearson correlation coefficients(ρ) were determined. Predictive values depend on the prevalence of a disease in a population. Because the prevalence of IA in a 1.5-lines-setting will differ from a primary care setting, post-test probabilities of IA were estimated for two lower prior-test probabilities as example, namely 20% (estimated probability in patients GPs belief IA is likely) and 2% (prior-test probability with less preselection by GPs), using likelihood ratios and nomograms.Results:A total of 1637 consecutive patients were studied. Median symptom duration was 13 weeks. 76% of patients marked ≥1swollen joint at the mannequin. 41% of patients had ≥1swollen joint at examination by rheumatologists. ρ was 0.20(patient-level)-0.26(joint-level).The sensitivity of patients-reported joint swelling was high, 87%, indicating that the majority of patients with IA had marked swelling on the mannequin. However the specificity was 31%, indicating that 69% of persons without IA had also done so. The LR+ was 1.25; the LR- 0.43. The PPV was 46%, the NPV 77%. Thus the PPV increased hardly (from 41% to 46%) and the NPV somewhat (from 59% to 77%). Also in settings with prior-test probabilities of 20% and 2%, estimated PPVs (from respectively 20% and 2% to 24% and 2%) and NPVs (from respectively 80% and 98% to 90% and 99%) hardly increased.Conclusion:Patient-reported joint swelling had little value in distinguishing patients with/without IA for different prior-test probabilities, and is less valuable in comparison to self-reported flare detection in established RA.References:[1]Barton JL, Criswell LA, Kaiser R, et al. Systematic review and metaanalysis of patient self-report versus trained assessor joint counts in rheumatoid arthritis. J Rheumatol 2009;36:2635-2641.Disclosure of Interests:None declared

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Can spinopelvic mobility be predicted in patients awaiting total hip arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.101b8.bjj-2019-0106.r1 ◽

2019 ◽

Vol 101-B (8) ◽

pp. 902-909 ◽

Cited By ~ 8

Author(s):

M. M. Innmann ◽

C. Merle ◽

T. Gotterbarm ◽

V. Ewerbeck ◽

P. E. Beaulé ◽

...

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcome Measures ◽

Screening Tools ◽

Sacral Slope ◽

Sitting Position ◽

Total Hip ◽

Patient Reported ◽

Hip Flexion

Aims This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. Patients and Methods A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility. Results Standing to sitting, the hip flexed by a mean of 57° (sd 17°), the pelvis tilted backwards by a mean of 20° (sd 12°), and the lumbar spine flexed by a mean of 20° (sd 14°); strong correlations were detected. There was no difference in PROMs between patients in the different spinopelvic mobility groups. Maximum hip flexion, standing PT, and standing AI were independent predictors of spinopelvic mobility (R2 = 0.42). The combined thresholds for standing was PT ≥ 13° and hip flexion ≥ 88° in the clinical examination, and had 90% sensitivity and 63% specificity of predicting spinopelvic stiffness, while SS ≥ 42° had 84% sensitivity and 67% specificity of predicting spinopelvic hypermobility. Conclusion The hip, on average, accounts for three-quarters of the standing-to-sitting movement, but there is great variation. Abnormal spinopelvic mobility cannot be screened with PROMs. However, clinical and standing radiological features can predict spinopelvic mobility with good enough accuracy, allowing them to be used as reliable screening tools. Cite this article: Bone Joint J 2019;101-B:902–909.

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Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery

Foot & Ankle International ◽

10.1177/1071100719831392 ◽

2019 ◽

Vol 40 (6) ◽

pp. 694-701 ◽

Cited By ~ 3

Author(s):

Sameer Desai ◽

Alexander C. Peterson ◽

Kevin Wing ◽

Alastair Younger ◽

Trafford Crump ◽

...

Keyword(s):

Activities Of Daily Living ◽

Hallux Valgus ◽

Daily Living ◽

Patient Reported Outcomes ◽

Minimally Important Difference ◽

Foot And Ankle ◽

Outcome Score ◽

Patient Reported ◽

Bunion Correction ◽

Correction Surgery

Background: Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery. Methods: The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient-reported outcomes between October 2013 and January 2018. This study used anchor- and distribution-based approaches to calculate the minimally important difference for the instrument’s 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study. Results: Using anchor- and distribution-based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function. Discussion: The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain’s lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16. Level of Evidence: Level III, retrospective comparative series.

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Clinically Significant Outcome Improvement After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome and Severe Femoral Torsion

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211034588 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110345

Author(s):

Steven F. DeFroda ◽

Thomas D. Alter ◽

Blake M. Bodendorfer ◽

Alexander C. Newhouse ◽

Felipe S. Bessa ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Impingement Syndrome ◽

Harris Hip Score ◽

Femoral Torsion ◽

Outcome Score ◽

Femoroacetabular Impingement Syndrome ◽

Patient Reported ◽

Outcome Improvement ◽

Clinically Significant

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

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Treatment of osteoarthritis with autologous, micro-fragmented adipose tissue: a study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05628-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rasmus Kramer Mikkelsen ◽

Lars Blønd ◽

Lisbeth Rosenkrantz Hölmich ◽

Cecilie Mølgaard ◽

Anders Troelsen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Adipose Tissue ◽

Knee Injury ◽

Primary Outcome ◽

Morphological Changes ◽

Controlled Trial ◽

Control Group ◽

Randomized Controlled ◽

Outcome Score ◽

Patient Reported

Abstract Background Osteoarthritis is a destructive joint disease that leads to degeneration of cartilage and other morphological changes in the joint. No medical treatment currently exists that can reverse these morphological changes. Intra-articular injection with autologous, micro-fragmented adipose tissue has been suggested to relieve symptoms. Methods/Design The study is a blinded randomized controlled trial with patients allocated in a 1:1 ratio to 2 parallel groups. Patients suffering from pain and functional impairment due to osteoarthritis Kellgren-Lawrence grades 2–3 in the tibiofemoral joint are eligible for inclusion. The intervention group is treated with an intra-articular injection with autologous, micro-fragmented adipose tissue prepared using the Lipogems® system. The control group receives an intra-articular injection with isotonic saline. In total, 120 patients are to be included. The primary outcome is The Knee injury and Osteoarthritis Outcome Score (KOOS4) evaluated at 6 months. Secondary outcomes are KOOS at 3, 12 and 24 months; the Tegner activity score; treatment failure; and work status of the patient. The analysis will be conducted both as intention-to-treat and per-protocol analysis. Discussion This trial is the first to investigate the efficacy of autologous, micro-fragmented adipose tissue in a randomized controlled trial. The study uses the patient-reported outcome measure Knee Injury and Osteoarthritis Outcome Score (KOOS4) after 6 months as the primary outcome, as it is believed to be a valid measure to assess the patient’s opinion about their knee and associated problems when suffering from osteoarthritis.

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A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0033 ◽

2017 ◽

Vol 26 (3) ◽

pp. 260-268

Author(s):

Patti Syvertson ◽

Emily Dietz ◽

Monica Matocha ◽

Janet McMurray ◽

Russell Baker ◽

...

Keyword(s):

Outcome Measures ◽

Repeated Measures ◽

Rating Scale ◽

Case Series ◽

Numeric Rating Scale ◽

Achilles Tendinopathy ◽

Global Rating ◽

Physically Active ◽

Indirect Treatment

Context:Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.Objective:To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.Participants:11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.Design:Case series.Setting:Participants were evaluated, diagnosed, and treated at multiple clinics.Main Outcome Measures:Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.Results:A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.Conclusion:The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

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