Comprehensive Performance-Based Movement System Screening Tool for Athletes A Thesis Submitted to the Faculty of Drexel University by Courtney Butowicz, MSEd, CSCS in partial fulfillment of the requirements for the degree of Doctor of Philosophy June 2016 Copyright 2016 Courtney Butowicz. All Rights Reserved ii DEDICATIONS This dissertation and all my hard works are dedicated to my family, friends, and my dog Cooper. Without their love, support, and laughter, this process would have never been possible. iii ACKNOWEDGEMENTS This dissertation was funded, in part, by the American Physical Therapy Association, Sports Section Legacy Fund Grant. I would like to extend my gratitude to my committee members: Dr. Sheri Silfies, Dr. David Ebaugh, Dr. Clare Milner, Dr. Jimmy Onate, and Dr. Stella Volpe for their constructive and insightful feedback. In addition, I would like to acknowledge and thank Dr. Sara Tomaszewski, Dr. Jeffrey O’Neill, and Dr. Sarah Wenger for their invaluable assistance and insight during the development of this dissertation project. I cannot express enough gratitude to my advisor, Dr. Sheri P. Silfies for her mentoring, support, encouragement, and willingness to read and correct countless drafts of abstracts, proposals, manuscripts, and posters. Dr. Silfies gave me an opportunity to get involved and help in ongoing research projects, thereby considerably facilitating my learning process. I could not have completed this entire PhD process without her intelligence, guidance, and support. I am thankful to PhD students: Dr. Pete Wattananon, Marisa Pontillo, Bryan Spinelli, Won Sung, Han Chen, Mike Bijman, and Trey Brindle for their support and encouragement throughout my PhD study. I would like to especially thank Won and Marisa for answering my endless questions and always providing me useful feedback from different perspectives based upon their clinical and research experiences. Finally, I am deeply grateful to my mom and stepdad, Jan and Teddy Harris, for their unconditional love and support. And lastly, I would like to thank Erin and Jesse Crespo, Mindy Leher, Krista Tobin, and Jen Darley for being my family away from home and always being there for me throughout this process. iv TABLE OF CONTENTS LIST OF TABLES ......................................................................................................... vii LIST OF FIGURES .......................................................................................................... x ABSTRACT ................................................................................................................... xii CHAPTER ONE: PROPOSAL ........................................................................................ 1 ABSTRACT ......................................................................................................... 1 SPECIFIC AIMS .................................................................................................. 3 SIGNIFICANCE AND INNOVATION .............................................................. 8 BACKGROUND ................................................................................................ 11 PRELIMINARY STUDIES ............................................................................... 41 RESEARCH DESIGN AND METHODS .......................................................... 63 POTENTIAL PROBLEMS AND ALTERNATIVE STRATEGIES ................. 78 REFERENCES ................................................................................................... 81 CHAPTER TWO: VALIDATION OF CLINICAL TESTS OF CORE STABILITY: AN A PRIORI HYPOTHESES CONVERGENT AND DIVERGENT VALIDITY APPROACH ............................................................. 92 ABSTRACT ....................................................................................................... 93 INTRODUCTION .............................................................................................. 95 METHODS ......................................................................................................... 98 Study Design .......................................................................................... 98 Subjects ................................................................................................... 98 Procedures .............................................................................................. 99 RESULTS ......................................................................................................... 109 DISCUSSION ................................................................................................... 110 v CONCLUSION ................................................................................................ 113 REFERENCES ................................................................................................. 123 CHAPTER THREE: CONSTRUCT VALIDITY AND RELIABILITY OF A NOVEL COMPREHENSIVE MOVEMENT SYSTEM SCREENING TOOL .................................................................................................... 126 ABSTRACT ..................................................................................................... 127 INTRODUCTION ............................................................................................ 129 METHODS ....................................................................................................... 132 Study Design ........................................................................................ 132 Subjects ................................................................................................. 133 Procedures ............................................................................................ 134 RESULTS ......................................................................................................... 137 DISCUSSION ................................................................................................... 138 CONCLUSION ................................................................................................ 141 REFERENCES ................................................................................................. 158 CHAPTER FOUR: MOVEMENT SYSTEM PERFORMANCE DIFFERENCES IN ATHLETES WITH AND WITHOUT A NON-TRAUMATIC SHOULDER INJURY ........................................................... 164 ABSTRACT ..................................................................................................... 165 INTRODUCTION ............................................................................................ 167 METHODS ....................................................................................................... 170 Study Design ........................................................................................ 170 Subjects ................................................................................................. 170 Procedures ............................................................................................ 171 RESULTS ......................................................................................................... 177 vi DISCUSSION ................................................................................................... 178 CONCLUSION ................................................................................................ 181 REFERENCES ................................................................................................. 194 CHAPTER FIVE: SUMMARY ................................................................................... 199 SPECIFIC AIM 1A .......................................................................................... 200 SPECIFIC AIM 1B ........................................................................................... 203 SPECIFIC AIM 2A .......................................................................................... 205 SPECIFIC AIM 2B ........................................................................................... 209 SPECIFIC AIM 2C ........................................................................................... 214 SPECIFIC AIM 3A .......................................................................................... 215 SPECIFIC AIM 3B ........................................................................................... 217 LIMITATIONS ................................................................................................ 218 IMPLICATIONS FOR REHABILITATION ................................................... 221 RECOMMENDATIONS FOR FUTURE STUDIES ....................................... 222 REFERENCES ................................................................................................. 224 APPENDICES .............................................................................................................. 227 APPENDIX 1: DOUBLE LEG LOWERING TEST ....................................... 227 APPENDIX 2: EXPERT PANEL DEMOGRAPHICS .................................... 227 APPENDIX 3: MSST DATA COLLECTION SHEETS ................................. 228 APPENDIX 4: MSST DETAILED SCHEMA ................................................ 232 APPENDIX 5: LAB-BASED TEST OF CORE STABILITY ......................... 234 APPENDIX 6: MSST MANUAL .................................................................... 242 APPENDIX 7: PRELIMINARY INTER RATER RELIABILITY ................. 278 vii APPENDIX 8: SPORTS ACTIVITY QUESTIONNAIRE ............................. 279 APPENDIX 9: DATA COLLECTION