International Journal of Sports Physical Therapy最新文献

Background: Baseball players, coaches, and clinicians have sought to leverage biomechanical devices to inform training load and injury prevention. A novel biomechanical pitching sleeve and portable force plate have been proposed to track training load, kinetic, and kinematic data. The objective of this study was to identify the barriers and facilitators for use of wearable and portable biomechanical devices among elite baseball pitchers and training staff.

Study design: Qualitative descriptive study nested within a pilot feasibility study.

Methods: This study was conducted at participating team facilities. Collegiate baseball players, coaches, and support staff were recruited. Nine semi-structured focus groups/interviews were conducted using a qualitative guide book and transcribed verbatim. An abductive conventional content analysis was adopted to construct themes for barriers and facilitators for implementation of the novel biomechanical pitching sleeve and portable force plate.

Results: Three themes emerged related to facilitators for the use of the devices. First, knowledge users valued individualized data-informed training. Second, athletes felt empowered to make training decisions through self-awareness. Third, users had a new appreciation for injury prevention strategies. Two themes emerged related to barriers for the use of the devices. First, the data interpretation imposed implementation challenges. Second, the addressing challenges in systemization and integration.

Conclusions: This study provides insight into barriers and facilitators that may improve future implementation of wearable or portable biomechanical devices among players, coaches, and clinicians to aid in informing training regimens and injury prevention strategies.

Background: Sports medicine physicians routinely evaluate and treat young athletes-children and adolescents (6-18 years) participating in organized sports-with extension-based low back pain (EBLBP). This condition is most often associated with spondylolysis, spondylolisthesis, stress reaction, or other mechanical causes. However, there is no consensus regarding the appropriate use and timing of imaging in this population, particularly given concerns about radiation exposure and health care costs.

Purpose: To describe the imaging practices of sports medicine physicians managing young athletes with EBLBP and to identify physician and contextual factors associated with potential overutilization, in order to inform evidence-based recommendations.

Methods: A 13-question online survey focusing on imaging and treatment preferences for young athletes with EBLBP was emailed to 2,185 sports medicine physicians. Responses were summarized with descriptive statistics, and exploratory subgroup analyses were performed by percentage of sports medicine in the practice, practice setting, and years in sports medicine practice.

Results: A total of 397 physicians completed the survey. Almost three-quarters 271 (68%) reported that they always or most of the time order radiographs on the first visit. Advanced imaging was ordered on the first visit by 13.1% and within four weeks by an additional 27.2%. MRI was the preferred advanced imaging modality (69.3%), followed by SPECT (19.2%) and CT (5.0%). Initial radiograph use was high across subgroups and was most common in orthopedic offices, private sports medicine settings, and among less-experienced physicians. Practice setting, years in practice, and sports-medicine caseload were also associated with differences in advanced imaging. MRI was the predominant modality across groups, while SPECT use was more frequent in orthopedic and private sports practices, varied across sports medicine caseload groups, and was higher among those with more years in practice.

Conclusion: Sports medicine physicians frequently obtain radiographs and, in many cases, advanced imaging early in the evaluation of young athletes with EBLBP. Given that most cases improve with conservative management and that delayed imaging does not appear to worsen outcomes, these findings may support efforts to reduce unnecessary imaging and establish clearer, evidence-based guidelines for this athletic population.

Level of evidence: 3.

Background and purpose: Evidence concludes that aerobic exercise, exercise therapy, and manual therapy effectively improve pain and function in individuals with hip osteoarthritis (OA). The American College of Rheumatology (ACR) reports there is no consensus on which type of exercise elicits the greatest benefit for those with OA. The American Academy of Orthopedic Surgeons (AAOS) cites gaps in the physical therapy literature regarding failure to stratify severity of hip OA in the context of exercise interventions. The purpose of this case report was to examine the benefits of a stratified, tailored multimodal approach for an individual with moderate hip OA.

Case description: A 75-year-old male and recreational runner of more than 40 years presented with an insidious onset of worsening hip pain. The Lower Extremity Functional Scale (LEFS) and Visual Analog Scale (VAS) at rest were utilized to stratify the subject's hip OA severity, and the subject was assessed as moderate severity. Long run mileage and total weekly running mileage were tracked as a measure of progress towards the subject's functional goals. The subject's therapeutic goals included decreasing pain and improving function to complete a half-marathon scheduled for four months after the initial evaluation. The subject completed a physical therapy plan of care spanning twice weekly for six weeks, twelve total visits. The multimodal approach consisted of manual therapy, supervised exercise therapy, and an unsupervised home exercise program (HEP).

Outcomes: The subject improved in all primary outcomes. The LEFS improved from 32/80 to 50/80; the VAS improved from 61/100 to 52/100; and hip active range of motion improved for flexion 90° to 110°, IR 10° to 20°, and ER 30° to 35°. The subject's functional measures improved from long runs spanning 4.0 miles to 8.0 miles and total weekly running mileage from 10.0 miles to 28.0 miles without limitation.

Discussion: The six-week, multimodal approach effectively reduced pain and increased function in this recreational runner. Individualized exercise therapy and the use of a critical magnitude of force used during manual therapy were two important tenets of an effective multimodal program for this subject. Moreover, the severity of OA and contextual factors might be significant considerations to guide future interventions.

Level of evidence: 5.

Background: Reactive strength index (RSI) derived from single-leg vertical continuous jumps (SVCJ) is a low-cost method to assist in making return-to-sport (RTS) decisions after anterior cruciate ligament reconstruction (ACLR); however, its relationship with isokinetic knee strength at different postoperative time points remains unclear. The purpose of this study was to explore the relationship between the RSI during SVCJ and isokinetic knee muscle strength in patients five to eight months after ACLR.

Study design: Retrospective cohort study.

Methods: Patients who had undergone primary ACLR with hamstring tendon autografts were enrolled. At five, seven, and eight months postoperatively, the participants performed 15 SVCJ recorded on an iPad at 240 fps. RSI was calculated as jump height divided by ground contact time, with flight time and contact time derived from video analysis using a validated smartphone/tablet application. Isokinetic peak knee extension and flexion torques were measured bilaterally at 60°/s using the Biodex System 3. Limb symmetry index (LSI) was calculated for both isokinetic knee strength and RSI as (operated limb value / non-operated limb value) × 100 (%). Time effects were analyzed using repeated-measures analysis of variance, and Pearson correlations assessed associations between RSI and knee strength.

Results: Twelve competitive athletes (mean age, 34.3 ± 11.3 years), participating in cutting- and jumping-based sports were analyzed. Isokinetic knee flexion peak torque significantly improved from five to eight months (p < 0.05) postoperatively. The extension-strength LSI was 75% at eight months, whereas the flexion-strength LSI increased from 84.5% at five months to 93.5% at eight months. The RSI LSI reached 83.1% at eight months. Correlations between RSI and knee extension strength were strong and significant at five months (r = 0.81, p < 0.01) and seven months (r = 0.91, p < 0.01) but were weak and not significant at eight months (r = 0.36, p = 0.26).

Conclusion: RSI may serve as a surrogate for isokinetic knee extension strength during midterm rehabilitation after ACLR, later reflecting higher-order explosive performance; smartphone/tablet-based assessment supports staged RTS decision making.

Level of evidence: 2b.

Background: Hip and trunk ("core") muscle dysfunction has emerged as a modifiable contributor to lower-limb biomechanics linked with non-contact anterior cruciate ligament (ACL) injuries. Clinicians increasingly target core stability and control during injury-prevention screening and post-operative rehabilitation programs; however, the literature lacks a focused synthesis of core-directed strategies for ACL injury mitigation. The purpose of this current concepts review is to synthesize current evidence on hip- and core-focused assessment and rehabilitation strategies that may mitigate ACL injury risk.

Design: Current Concepts Review.

Methods: A narrative search of PubMed and Google Scholar (January 2000 - April 2025) identified biomechanical, prospective, interventional, and return-to-sport studies examining relationships between hip and/or trunk muscle function and ACL injury risk or recovery. Key findings were organized into (1) injury mechanisms, (2) screening and return-to-play (RTP) tests, and (3) preventive and rehabilitative interventions, with special attention to sex-specific evidence.

Results: Prospective and biomechanical studies consistently show that reduced hip abduction/extension strength and diminished trunk neuromuscular control predict dynamic knee valgus and elevated ACL strain. Functional assessments such as the single-leg step-down, Y-Balance, modified Star Excursion test, hop symmetry, and muscular assessment via belt-stabilized hand-held dynamometry-reliably identify high-risk athletes and persistently impaired post-ACLR patients. Multi-component neuromuscular programs emphasizing hip and core strengthening lower overall knee-ligament injury rates by 20-60 % in youth cohorts, with larger effects in females. Early incorporation of hip/trunk exercises during rehabilitation post ACLR contributes to improved kinematics, hop performance, and patient-reported outcomes, although standardized parameters remain undefined.

Conclusion: Evidence supports routine integration of hip and trunk assessment and strengthening into ACL injury-mitigation, rehabilitation, and RTP decision-making protocols. Future research should refine trunk-specific evaluation tools and establish optimal exercise dosing across sexes and competition levels.

Level of evidence: 5.

Background: Anatomic humeral retrotorsion (aHRT) influences objective measures of glenohumeral external (GER) and internal rotation (GIR) range of motion (ROM) in baseball players. Baseball players often display GER deficits within the context of aHRT; however, this has yet to be studied in a softball population. Hypothesis/Purpose: 1) To determine if there are differences in GER ROM, GIR ROM, total range of motion (TROM), aHRT, relative humeral retrotorsion (rHRT), and HRT-corrected motion between collegiate softball position players and pitchers, 2) to determine if differences exist between GER and HRT-corrected GER and GIR and HRT-corrected GIR in collegiate softball players, regardless of position.

Study design: Retrospective Descriptive Study.

Methods: Sixty-three healthy Division I softball players participated. Objective measures of GER, GIR, and aHRT on the throwing arm and non-throwing were collected using a digital inclinometer at various timepoints during the 2023-2024 seasons. TROM, rHRT, and HRT-corrected motions were calculated from objective measurements on the throwing arm and non-throwing arm. Independent t-tests were used to determine differences in objective ROM and HRT measures between position. Paired t-tests were used to determine differences between objective ROM and HRT-corrected ROM in both the pitching and position player cohorts. Effect sizes were calculated.

Results: There were no significant differences in GER, GIR, TROM, aHRT, rHRT, HRT-corrected GER, and HRT-corrected GIR by player position (p> 0.05). Effect sizes ranged from -0.27-0.57. There were differences in position players between GER (5 ± 8°) and HRT-corrected GER (-11 ± 14°) (p < 0.001) and GIR (-10 ± 10°) and HRT-corrected GIR (6 ± 12°) (p < 0.001). There were differences in pitchers between GER (1 ± 8°) and HRT-corrected GER (-11 ± 11°) (p < 0.001) and GIR (-7 ± 9°) and HRT-corrected GIR (5 ± 10°) (p < 0.001).

Conclusion: When glenohumeral ROM is interpreted within the context of rHRT, GIR deficits are not common in softball players. Based on the current findings, it is imperative that rHRT be assessed in all softball players as this information will aid in the identification of true motion restrictions.

Level of evidence: 3.

Capitellar osteochondral dissecans (OCD) is a prevalent condition in competitive gymnasts. While evidence-based guidelines for management of OCD are available in baseball players, this is not the case for gymnasts. OCD can be managed surgically with an Osteochondral Autograft Transfer System (OATS) procedure followed by rehabilitation or conservatively with rehabilitation alone. A comprehensive approach to rehabilitation of OCD, integrating a criterion-based progression, may optimize return to sport success. The purpose of this clinical commentary is to review the literature and summarize current concepts in rehabilitation following both surgical intervention and conservative management of OCD in gymnasts. Level of Evidence Level 5.

The radiocarpal joint is a synovial joint of the distal wrist that is formed between the radius and the proximal row of carpal bones, the scaphoid, lunate and triquetral bones. Wrist injuries are common and occur from overuse and trauma. The radiocarpal joint is composed of the proximal concave surface of the radius and the articular disc or triangular fibrocartilage. The distal portion of this joint includes the convex row of carpal bones. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating wrist ligaments, discs and bones. MSKUS is excellent at detecting changes in ligament composition and continuity. This manuscript will review the utility of MSKUS in evaluating the radiocarpal joint injury including anatomy, common mechanism of injury patterns, sonographic techniques, and clinical implications for those in the rehabilitation profession. Due to its small size, and variety of structures in a small space, diagnosis of acute radiocarpal injury by physical examination is often difficult. By integrating MSKUS into clinical practice, providers can improve the accuracy of diagnosis, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to optimal patient outcomes for those with wrist injuries.