Neal R Glaviano

• Athletic Training
• Professor (Assistant) at University of Connecticut

Background The Nordic hamstring exercise (NHE) has been widely used among uninjured, athletic populations to mitigate the risk of hamstring injury, yet little is known about its utility as an intervention for individuals who undergo ACL reconstruction with hamstring tendon autograft (ACLR-HT). Understanding the feasibility of NHE as a means of enha...

Background Portable dynamometers (PD) are widely used to assess hip muscle strength; however, few studies have explored their validity and agreement when evaluating the rate of torque development (RTD) of hip muscles, particularly with different fixation methods. Hypothesis/Purpose The purpose of this study was to determine the validity and agreem...

Background Belt-stabilized handheld dynamometers (HHD) assess hip rate of torque development (RTD) and strength in research and clinical practice. However, the reliability of HHD with push and pull configurations to measure hip muscles RTD and peak torque is unclear. Purpose/Hypothesis To determine the intra- and inter-reliability of HHD utilizing...

Context: Handheld dynamometers provide clinicians an objective measure of lower-extremity force production at the hip and knee. While push-based dynamometers are common in clinical practice, they can be associated with patient discomfort, and standardization of methods is challenging when patient forces can exceed the ability of the rater. Develop...

Clinical Scenario: Individuals with patellofemoral pain (PFP) present with a variety of neuromuscular and psychological deficits, with the “gold-standard” for treatment being rehabilitation programs with strengthening-based exercises. While such interventions primarily target pain and function measures, it is unknown whether psychological measures...

Objectives: To (1) compare physical activity variability between individuals with patellofemoral pain (PFP) and pain-free individuals and (2) evaluate the relationships of physical activity variability with pain severity, symptom duration, disability, and pain catastrophizing in PFP cohorts. Design: Cross-sectional case-control study. Setting: Univ...

Patellofemoral pain (PFP) often presents pain, disability, and psychological barriers during daily activities, reducing overall physical activity (PA). However, there is a lack of evidence on how PFP affects PA variability and its relation to clinical and psychological outcomes in PFP cohorts. PURPOSE: To compare PA variability between people with...

PURPOSE: To evaluate the association between daily pain and daily PA levels in individuals with and without PFP over a two-week period. METHODS: Fifty-five individuals with PFP (23.1±4.0 y) and 38 pain-free controls (23.9±4.1 y) completed the study. Participants wore an ActiGraph wGT3X-BT for two weeks to assess minutes of moderate to vigorous phys...

Background: Dysfunction in efferent pathways after knee pathology is tied to long-term impairments in quadriceps and hamstrings muscle performance, daily function, and health-related quality of life. Understanding the underlying etiology is crucial for effective treatment and prevention of poor outcomes, such as post-traumatic osteoarthritis or joi...

Context: Existing patellofemoral pain (PFP) literature has primarily focused on quadriceps muscle volume, with limited attention given to the lower limbs deep and superficial muscle volumes in individuals with unilateral and bilateral PFP. This research aims to fill this gap. Objective: To explore superficial and deep lower extremity muscle volume...

Background: Patellofemoral pain (PFP) affects physical and psychosocial health; however, it is unclear if unilateral and bilateral PFP induce similar levels of impairments. Objectives: We aimed to compare physical activity (PA), pain self-efficacy, and disability between individuals with unilateral and bilateral PFP, and to compare these groups aga...

Context Pain and symptoms of patellofemoral pain (PFP) are often exacerbated during daily activities, which may result in reduced overall physical activity levels. Objective To summarize the evidence for physical activity levels among persons with PFP compared with pain-free controls. Data Sources PubMed, Embase, CINHAL, Cochrane Library, and SPO...

Context: Patellofemoral pain (PFP) is a prevalent chronic condition characterized by retropatellar or peripatellar pain exacerbated by various knee flexion-based activities. Previous research has highlighted the impact of psychological constructs on pain and function in chronic musculoskeletal pain conditions, yet their influence on physical activi...

OBJECTIVE: To evaluate the association between lower extremity strength and clinical outcomes (pain or self-reported function) in individuals with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: PubMed, Scopus, and SPORTDiscus, from inception to February 2024. STUDY SELECTION CRITERIA: Peer-reviewed studi...

Context: Patellofemoral pain (PFP) is a frequent musculoskeletal condition, with females being twice as likely to develop PFP compared to males. PFP is commonly associated with hip and knee neuromuscular dysfunction, and inter-limb symmetry in neuromuscular function has been related to pain severity in PFP cohorts. Researchers have identified that...

Context: Patellofemoral pain (PFP) is a common condition that is twice as prevalent in females than males. Little evidence exists comparing differences in neuromuscular or biomechanical function between females and males with PFP. While moderate associations exist between hip torque and increased frontal plane kinematics in females; the association...

Introduction: Isometric hip strength seems to have limited association with frontal plane kinematics in individuals with patellofemoral pain (PFP), but little is known about the association with hip rate of torque development (RTD). Objective: To explore the association of hip strength and RTD with trunk, pelvis, hip, and knee kinematics during...

Assess the effectiveness of three cooling strategies during a 10-min break vs. no break or no cooling on internal body temperature responses during an intermittent treadmill exercise simulating the intensity of a tennis match. Twelve physically active females (mean ± SD; age, 26 ± 3 years; height, 167.0 ± 4.8 cm; body mass, 58.2 ± 4.2 kg; VO2peak 4...

Background Impaired knee extensor neuromuscular function has been frequently observed in individuals with patellofemoral pain (PFP); however, few researchers have aimed to understand the influence of sex on knee extensor neuromuscular function in this pathological population. The authors aimed to determine whether there are differences in knee exte...

Clinical Scenario: Patellofemoral pain (PFP) is a widespread knee disorder encountered in clinical practice. Clinicians have often focused on strengthening hip and knee musculature to improve pain and disability, which are the ultimate clinical goals of PFP treatment. However, PFP literature has shown improvement in pain and disability without conc...

OBJECTIVE: To summarize the evidence on reliability and criterion validity of hip muscle strength testing using portable dynamometers. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from inception to March 2023. STUDY SELECTION CRITERIA: We included studies investigating reliability or criterion validi...

To observe how knee proprioceptive acuity and quadriceps neuromuscular function change during and after repeated isokinetic knee-extension exercise in patients with anterior cruciate ligament reconstruction (ACLR) or meniscus surgery. Patients with ACLR or meniscus surgery and matched controls (n = 19 in each group) performed knee-flexion replicati...

Background: Impairments in hamstring strength, flexibility, and morphology have been associated with altered knee biomechanics, pain, and function. Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation. This systematic review aimed to s...

Background: Individuals with patellofemoral pain have a heterogeneous presentation of symptoms during functional tasks; however, biomechanical data often negates self-reported disability. The single leg squat is common in patellofemoral pain literature but may not be a pain provoking task for all individuals. Therefore, our study examined the infl...

Objectives: Compare lower extremity muscle volume in females with patellofemoral pain (PFP) to a cohort of pain-free females and investigate the relationship between thigh and hip muscle volume and torque. Design: Cross-sectional. Participants: Twenty-one females, 13 with PFP and 8 pain-free controls. Main outcome measures: We quantified normalized...

Context: Patellofemoral pain (PFP) is a prevalent orthopedic condition, with females being twice as likely to develop PFP than males. Although the etiology of PFP is indecisive, neuromuscular impairments such as lower extremity muscle weakness seem to play a crucial role. Lower extremity muscle weakness is limited to major muscle groups, preventing...

Context: Lateral ankle sprains are the most common lower extremity musculoskeletal injury among physically active populations and often lead to chronic ankle instability (CAI). The Star Excursion Balance Test (SEBT) is a clinical movement assessment to evaluate dynamic postural control and frequently used in individuals with CAI. A previously publi...

Context: Patellofemoral pain (PFP) is a challenging condition, affecting up to one in four individuals with knee-related disorders. Multiple PFP consensus statements provide clinical recommendations that support exercise therapy with the ultimate goal of improving pain and function; however, the direct association between lower extremity strength a...

Objective: To compare walking vertical ground reaction force loading rates (vGRF-LR) and their relationship to physical activity between individuals with and without PFP. Methods: Nine individuals with PFP (six females, 24.3.2±2.5 years, 165.4±6.7 cm, 62.7±6.9 kg, symptom duration: 65.2±53.4 months) and eight pain-free individuals (five females, 23...

Objective: To evaluate the relationship between physical activity levels and patient-reported pain self-efficacy in individuals with patellofemoral pain (PFP). Methods: We recruited individuals with PFP through social media and public flyers for this cross-sectional study. Participants were screened in accordance with the PFP consensus statement i...

Objective: To explore lower extremity muscle volume in women with unilateral or bilateral patellofemoral pain (PFP) compared to a normative database of pain-free women. Methods: Twenty women with PFP (10 unilateral: 21.2±4.9 years, 23.8 ±5.0 kg/m2; 10 bilateral: 25.8±3.1 years, 21.9±2.4 kg/m2) completed this cross-sectional study. We quantified low...

Objective: We aimed to systematically review and synthesize the evidence for physical activity (PA) levels among individuals with patellofemoral pain (PFP) compared to pain-free controls. Methods: This systematic review with meta-analysis conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We condu...

Patellofemoral pain is a prevalent condition among physically active individuals.

Objectives: Despite the growing use of whole-body vibration (WBV) to enhance quadriceps neuromuscular function, the hamstrings-specific response is unclear among those without neuromuscular impairment, which is important to inform performance-based recommendations. Our objective was to determine the immediate and prolonged effects of WBV on hamstr...

Background Psychological barriers due to anterior knee pain (AKP) and anterior cruciate ligament reconstruction (ACLR) may have a direct impact on an individual’s return to physical activity. A comprehensive understanding of these psychological barriers in individuals with AKP and ACLR may help clinicians to develop and implement better treatment s...

Patellofemoral pain (PFP) is a chronic condition that presents with patellar pain during various daily and recreational activities. Individuals with PFP have a wide range of impairments that result in long-term disability and reduced quality of life. Current interventions target hip muscle weakness with strength-based exercises, but recurrence rate...

Context Exercise-induced fatigue reduces muscle force production and motoneuron pool excitability. However, it is unclear if patients with patellofemoral pain (PFP) experience further loss in quadriceps neuromuscular function due to fatigue during and after exercise. Objective To observe how quadriceps maximal strength, activation, and force-gener...

Background The single-leg squat (SLS) is often used to measure two-dimensional frontal plane motion; however, there is a variability in the SLS depth across studies. Research question Are knee abduction (KABD), hip adduction (HADD), pelvic drop (PD), and lateral trunk flexion (LTF) angles different at greater knee flexion angles during a SLS? Met...

Objectives To evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks. Des...

Context: Patellofemoral pain (PFP) accounts for 25% of all knee-related pathologies, with females being twice as likely to experience PFP compared with males. Altered movement strategies of the trunk and lower extremity have been identified in the PFP literature; however, the association between proximal and local biomechanical factors is still poo...

Context: PFP is a chronic condition that results in long-term disability and functional limitations. Physical activity level is impaired in those with PFP, with fewer steps per day and less time in mild and vigorous physical activity compared to healthy controls. The comparison between unilateral and bilateral PFP influences sport participation, ho...

The purpose of this study was to compare neuromuscular function in the upper extremity musculature between individuals with glenohumeral labrum repair and uninjured controls. This cross‐sectional study examined 16 individuals with a primary, unilateral glenohumeral labral repair (male/female: 13/3, age: 24.1±5.0 years, time from surgery: 36.7±33.3...

Objectives To compare beliefs of physical therapists (PTs) who read the clinical practice guideline (CPG) for the management of individuals with patellofemoral pain (PFP) to those who have not read the CPG. Design Cross-sectional study. Setting Online survey. Participants 494 currently licensed/registered PTs or physiotherapists. Main outcome m...

OBJECTIVE: Lumbopelvic-hip complex (LPHC) stability is related to altered movement patterns that are present in individuals with PFP. Current studies measuring LPHC function in PFP primarily assess endurance and not stability. A test of isolated LPHC stability, the Seated Trunk Control Test (STCT) was recently developed and test-retest reliability...

Objective Patellofemoral pain (PFP) is a common musculoskeletal condition, which has a negative effect on physical activity and function. Currently, it is unknown how and why individuals with PFP modify their physical activity. The purpose of this qualitative study was to explore the experience of knee pain on physical activity and everyday life in...

Reliable techniques to assess centrally mediated function in healthy individuals are essential to understand the origins of neuromuscular dysfunction in pathologic populations. This study examined the test–retest reliability of corticospinal excitability in the upper extremity musculature of 21 healthy individuals using transcranial magnetic stimul...

Objectives Patellofemoral pain (PFP) is a common lower extremity condition that results in pain during functional tasks. Currently, it is unknown the extent to which differences in pain levels exist in individuals with PFP compared to asymptomatic controls during functional task and if pain differ across various functional tasks. The purpose of thi...

Context: Gluteus medius (GMed) weakness is a common impairment seen across multiple lower-extremity pathologies. Greater GMed weakness is moderately associated with greater frontal plane motion, often termed dynamic knee valgus during functional tasks which may increase risk of lower-extremity injury. Neuromuscular electrical stimulation (NMES) su...

Context: Lesser hip muscle strength is commonly observed in females with patellofemoral pain (PFP) compared with females without PFP and is associated with poor subjective function and single-leg squat (SLS) biomechanics. Hip muscle weakness is theorized to be related to PFP, suggesting centrally mediated muscle inhibition may influence the observ...

Context: Lumbopelvic-hip complex (LPHC) exercises are used to increase stabilization within the human body. Torso-elevated side support (TESS), foot-elevated side support (FESS), prone bridge plank (PBP), and V-sit are common LPHC exercises. Objective: To evaluate muscle activation in the shoulder girdle and LPHC during 4 LPHC exercises and eval...

Background Hamstrings neuromuscular function is a crucial component of functional movement, and changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings neuromuscular function in patients with ACL r...

Background Hamstrings muscle morphology is determinant of muscle function (i.e. strength). Among individuals with ACL reconstruction (ACLR), less cross-sectional area (CSA) and volume in the ACLR-limb are associated with muscle weakness, and may contribute to lower rates of return to preinjury activity level and an increased risk for long-term sequ...

Individuals with patellofemoral pain (PFP) experience pain during various functional activities. Long-term pain is a common consequence of PFP, yet little is known about daily pain variability. Twenty-five individuals with PFP completed the Anterior Knee Pain Scale (AKPS) and recorded daily pain over 10-days. Pain was evaluated by two measures of i...

Context: Patellofemoral pain (PFP) is prevalent and challenging to manage. Most people with PFP are unsatisfied with their knee function 6-months following treatment, and report ongoing pain up to 16-years after diagnosis. Confidence and knowledge to provide evidence-based care to people with PFP amongst Athletic Trainers (ATs) is currently unknow...

Clinical Scenario: Patellofemoral pain (PFP) is characterized by general anterior knee pain around the patella and is one of the most prevalent knee conditions. PFP is challenging to treat due to a wide range of contributing factors and often has chronic, reoccurring symptoms. Traditional treatment focuses on quadriceps and gluteal strengthening wi...

Background Differences in the excitability of motor generating neural pathways are reported following anterior cruciate ligament reconstruction (ACLR) that is associated with quadriceps dysfunction and theorized to prevent the full recovery of muscle function. Objective The aims of this systematic review and meta-analysis were to compare quadricep...

Objectives To investigate the relationship between (Smith et al., 2018): knee flexor strength, rate of torque development (RTD), and flexibility with pain level (Crossley et al., 2016); knee flexor strength and RTD with the performance in the single leg bridge test (SLBT) in women and men with patellofemoral pain (PFP). Design Cross-sectional. Set...

Background While traditionally viewed as a beneficial adaptation to preserve stability in the presence of knee pathology, excessive muscle co-activation may be detrimental for joint health when extrapolated to repetitive movement patterns over time. Lesser hamstrings strength relative to the quadriceps (low H:Q strength ratio) may influence neuromu...

Context: Anterior knee pain (AKP) is ubiquitous in early-career military members and exacerbated during functional tasks required during military duties. Therefore, it is important to understand risk of this condition in male and female tactical athletes in diverse military occupations. Objective: To assess sex and occupation on AKP risk in militar...

Objectives To observe isolated lumbopelvic-hip complex (LPHC) stability and muscle activity using the Seated Trunk Control Test (STCT) and evaluate the relationship between LPHC stability and 2-dimensional kinematics during movements. Design Descriptive Study. Setting Laboratory. Participants 22 healthy participants (12F, 10M, 23.5 ± 3.1yrs, 173...

Purpose Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns i...

Context: Hip muscle strength has previously been evaluated in various sagittal plane testing positions. Altering the testing position appears to have an influence on hip muscle torque during hip extension, abduction, and external rotation. However, it is unknown how altering the testing position influences hip muscle activity during these commonly...

Focused Clinical Question : Is low-load exercise training with blood flow restriction (LL-BFR) more effective at increasing muscle strength compared to low-level (LL) or high-level (HL) exercise training in individuals with muscle weakness? Clinical Bottom Line : The results of the systematic review with meta-analysis concluded that there is eviden...

Background: Anterior knee pain (AKP) is commonly diagnosed in military members and is a threat to operational readiness. AKP includes a range of conditions, with localized pain around the patella being a frequent location of pain and disability. Mechanical overuse is one suggested etiology for many of these conditions, suggesting occupational deman...

Objectives To investigate validity and between-session reliability of frontal plane trunk, hip, and knee kinematics during three functional tasks in females with patellofemoral pain (PFP). Design Observational Setting Research Laboratory Participants 20 females with PFP (22.7±3.2 years, 69.9±9.2kg, 167.7±9.6cm). Main outcome measures Trunk, hip...

Context Patellofemoral pain (PFP) is one of the most prevalent knee conditions observed in women. Current research suggests that individuals with PFP have altered muscle activity, kinematics, and kinetics during functional tasks. However, few authors have examined differences in lower extremity biomechanics in this population during the drop–vertic...

Impaired corticomotor function arising from altered intracortical and corticospinal pathways are theorized to impede muscle recovery following anterior cruciate ligament (ACL) surgery, yet functional implications of centrally driven adaptations remain unclear. We aimed to assess relationships between quadriceps corticomotor and neuromechanical func...

Two-dimensional assessments of the lower extremity and trunk are becoming more common in the sports medicine community. However, there is little evidence evaluating expert versus novice reliability or agreement of these measurements in healthy or pathological populations. The purpose of this study is to evaluate expert versus novice reliability and...

Context: Patellofemoral pain (PFP) is a challenging condition, with altered kinematics and muscle activity as 2 common impairments. Single applications of patterned electrical neuromuscular stimulation (PENS) have improved both kinematics and muscle activity in females with PFP; however, the use of PENS in conjunction with a rehabilitation program...

Context: Central activation ratio (CAR) is a common outcome measure used to quantify gross neuromuscular function of the quadriceps using the superimposed burst technique, yet this outcome measure has not been validated in the gluteal musculature. Objective: To quantify gluteus medius (GMed) and gluteus maximus (GMax) CAR in a healthy population...

Glaviano, NR and Saliba, S. Differences in gluteal and quadriceps muscle activation during weight-bearing exercises between female subjects with and without patellofemoral pain. J Strength Cond Res XX(X): 000-000, 2019-Therapeutic exercises targeting gluteal and quadriceps muscles have been previously investigated; however, these studies have only...

Context: Impaired scapular kinematics is commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. Objecti...

Context: Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its us...

Muscle weakness is a common impairment in females with patellofemoral pain (PFP), clinically seen in both the quadriceps and gluteal muscles. These weaknesses have been suggested to result in poor movement patterns, which results in the clinical presentation of pain due to increased stress on the patellofemoral joint. While quadriceps weakness have...

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries and as a response, clinicians often use external ankle taping prophylactically to reduce the prevalence of injuries. External ankle taping techniques have been shown to significantly reduce passive ankle range of motion; however, there is limited research on the effects...

Background: Females with patellofemoral pain (PFP) present with altered frontal plane kinematics, decreased physical activity, and elevated psychological features. However, the relationship between these factors has not been evaluated. Research question: Does a relationship exist between frontal plane kinematics, physical activity levels, and fe...

Objectives Patellofemoral pain (PFP) is a chronic condition that results in long-term subjective and objective impairments. PFP has been identified to result in modification in activity levels, however it is unknown the extent of activity levels in individuals with and without PFP. Design Case-control study. Participants 20 individuals with PFP a...

Introduction: We studied the ability of clinicians to identify quadriceps motor points using a transcutaneous electrical stimulation unit(TENS). Methods: Twenty-two certified athletic trainers and one expert-rater identified the seven motor points of the quadriceps at two time points separated by one week. The difference was calculated between w...

Objective: Evaluate the relationship between subjective knee function and lower extremity strength in individuals with patellofemoral pain(PFP). Design: Cohort. Setting: Laboratory. Participants: Participants were 30 individuals with PFP (20 females, 10 males; 76.02±17.88kg, 173.04±7.58cm, 24.9±7years). Main outcome measures: Subjects comp...