International Journal of Sports Physical Therapy最新文献

Background: Young female athletes have a substantial risk of suffering an anterior cruciate ligament (ACL) injury, in part due to sex-specific movement patterns. Injury prevention strategies targeting movement errors during a deceleration task may help decrease the associated risk. In order to enhance preventive interventions, screening tools to identify at-risk individuals are vital.

Hypothesis/purpose: To assess intra- and inter-rater reliability of a qualitative assessment of trunk and lower extremity alignment during a run plant task. It was hypothesized that the tool would demonstrate good to excellent intra- and inter-rater reliability.

Study design: Repeated measures.

Methods: Two Raters assessed videos of 25 healthy female athletes (ages 12-17 years) performing a run plant task. Female athletes were chosen due to their increased ACL injury risk. Raters used a qualitative checklist to assess trunk and lower extremity alignment, awarding one point for each observed movement fault. Item scores were then summed to generate a total score. Each video was scored twice with a two-week washout period in-between. Intraclass correlation coefficients (ICC) for each scoring item and the overall total score were calculated with a 2-way mixed-effect model and 95% confidence intervals (95% CIs) for inter- and intra-rater reliability.

Results: Intra-rater reliability was poor to moderate (Rater 1 ICC = 0.43, 95% CI 0.12-0.73; Rater 2 ICC = 0.54, 95% CI 0.20-0.87). Inter-rater reliability was moderate in round one (ICC = 0.66, 95% CI 0.41-0.90) and poor in round two (ICC = 0.32, 95% CI 0.02-0.63). Medial foot position was the only item to achieve good intra- and inter-rater reliability. Sagittal alignment also demonstrated good inter-rater reliability. In both rounds, dynamic valgus and preparatory deceleration steps were consistently marked as present (100% agreement), and lateral foot position was consistently marked as not present (100% agreement), by both Raters for all athletes.

Conclusion: While some individual items showed good reliability, several items and the total score failed to achieve acceptable reliability. Despite lower ICC values for dynamic valgus, preparatory deceleration steps, and lateral foot position, percent agreement was high. The skew and limited variability in these items likely influenced ICC estimates, suggesting that Rater consistency may be underestimated. Refinement of scoring item definitions for these items is needed prior to clinical application of the tool.

Level of evidence: Level 2, diagnosis.

Haglund's Syndrome is characterized by posterior superior calcaneal prominence with associated retrocalcaneal bursitis and insertional Achilles tendinopathy (IAT). Conservative management with physical therapy demonstrates strong evidence for efficacy and takes time. It is typically trialed for over a year, and if pain and dysfunction persist, surgical intervention is considered. Post-operative rehabilitation protocols described in the literature vary widely, with many restricting weightbearing for extended periods of time. This protocol emphasizes an expedited yet safe return to weightbearing for the patient to quickly normalize gait and return to evidence-based loading strategies. By aligning rehabilitation milestones with physiological healing timelines and objective criteria, this rehabilitation approach aims to optimize efficiency in recovery and facilitate a safe return to sport. The purpose of this clinical commentary is to review current literature and propose a criterion-based protocol recommending early weight bearing when significant repair of the tendon is not necessary. # Level of Evidence 5.

Background and purpose: Multiligamentous knee injuries present challenges to surgeons and rehabilitation specialists. Challenges can be complicated by postoperative infections, which impact patient outcomes. The knee stability and movement coordination impairments in this case are consistent with the Knee Ligament Sprain Clinical Practice Guideline, which provides a clinical framework for rehabilitation decision making following complex ligament reconstructions. This case report describes the rehabilitation management and outcomes following multiligament knee reconstruction complicated by septic arthritis after elective cosmetic surgery performed shortly after an orthopedic surgery.

Case description: A 22-year-old female recreational athlete (runner and gymnast) sustained a right tibiofemoral dislocation after a motor vehicle accident. A staged surgical approach was performed with posterolateral corner reconstruction followed by anterior and posterior cruciate ligament reconstruction four months later. Eight weeks after cruciate ligament reconstruction, the patient underwent elective cosmetic surgery with autologous fat grafting from the thigh. She developed a sudden onset of right knee pain and swelling and was diagnosed with septic arthritis. Arthroscopic irrigation, debridement, synovectomy, and intravenous antibiotics were administered. Rehabilitation progressed through a multi-phased protocol based on tissue healing and clinical readiness. Patient-reported outcomes included the International Knee Documentation Committee (IKDC), the ACL Return to Sport After Injury (ACL-RSI), and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and isokinetic testing.

Outcomes: The patient completed 36 sessions over 63 weeks from arthroscopic irrigation to the final physical therapy visit. IKDC increased by 17.24 points (MCID = 9.5), and ACL-RSI improved by 30 points (MIC = 15.1). OSPRO-YF decreased from five yellow flags to three. Isokinetic testing revealed a quadriceps peak torque-to-body weight ratio of 84.2%, with a limb symmetry index of 96.6%, surpassing normative values. She returned to an interval running program at 16 weeks and resumed coaching gymnastics at 28 weeks post-irrigation.

Discussion: This case highlights infection as a critical differential diagnosis in patients presenting with a painful knee effusion and describes septic arthritis occurring after an elective procedure performed shortly following orthopedic surgery.

Level of evidence: 4.

Background: The abdominal drawing-in maneuver (ADIM) is widely used in sports physical therapy and rehabilitation to selectively activate deep trunk muscles. Although the ADIM is effective for motor control retraining, previous studies suggest that it may be unsuitable as a breathing strategy during high-load tasks because it limits intra-abdominal pressure (IAP) generation. Trunk rotation in the horizontal plane is a fundamental component of many functional and sport-related movements and requires coordinated trunk stability and force production; however, the effects of the ADIM on IAP and torque during trunk rotation remain unclear.

Purpose: The purpose of the present study was to clarify the effects of the ADIM on IAP and trunk rotational torque during trunk rotation.

Study design: Crossover, randomized controlled study.

Methods: Fifteen healthy young adult males performed seated isometric trunk rotation tasks under two conditions: spontaneous rotation (SR) and trunk rotation with the ADIM (DIR). IAP was measured using a catheter-type pressure sensor. Trunk rotational torque was measured with a custom-manufactured trunk rotation dynamometer. Inspiratory volume was normalized as %inspiratory volume. Outcomes were compared between conditions.

Results: IAP was significantly greater in SR (96.7 ± 31.4 mmHg) than in DIR (34.9 ± 15.9 mmHg) (p < 0.01, d = 2.48). Torque was also significantly greater in SR (68.7 ± 20.2 Nm) than in DIR (49.1 ± 17.7 Nm) (p < 0.01, d = 1.03). %inspiratory volume was significantly greater in SR (66.9 ± 16.2%) compared with DIR (26.4 ± 17.4%) (p < 0.01, d = 2.41). Large effect sizes were observed for all outcomes.

Conclusion: Performing trunk rotation with the ADIM attenuated increases in IAP and trunk rotational torque. These findings indicate that ADIM influences both pressure generation and mechanical output during trunk rotation.

Level of evidence: 2.

Anterior shoulder instability, especially in contact athletes, is a relatively common sports pathology. Despite refinements in arthroscopic Bankart repair (ABR), recurrent instability and reoperation remain concerns in younger overhead and contact athletes. Remplissage has gained popularity through the years when used in conjunction with ABR. Adding remplissage to arthroscopic Bankart repair may lower the risk of recurrent instability. The purpose of this clinical commentary is to provide an evidence-based overview of arthroscopic Bankart repair with remplissage, including technique, biomechanics, outcomes, and indications.

Background: Midportion Achilles tendinopathy is a common injury affecting individuals across various activity levels, characterized by pain, impaired performance, and pathological changes in tendon structure. Although the clinical examination is crucial for diagnosis and management, the relationship between pain measures and tendon pathology remains unclear, prompting further investigation into their diagnostic and prognostic value.

Hypothesis/purpose: This study aimed to (1) investigate the relationship between diverse clinical pain measures - pain on palpation, recall pain, pain pressure threshold (PPT), and pain during hopping - and pathological tendon structure in individuals with midportion Achilles tendinopathy, and (2) determine whether these pain measures represent overlapping or distinct features of the pain experience.

Study design: Cross-Sectional Study.

Methods: One hundred and eighty-two participants with midportion Achilles tendinopathy completed clinical assessments for Achilles tendon pain (pain on palpation, recall pain, PPT, pain with hopping), and ultrasound imaging for Achilles tendon structure (thickness, degree of thickening, and cross-sectional area [CSA]) at a single visit. Spearman correlations were used to analyze the relationships between pain measures and Achilles tendon structure. Linear regression controlling for PPT was used to assess the relationship between pain on palpation and Achilles tendon structure.

Results: All pain measures were significantly related (|r| = .19 - .51, all p<0.018). Pain on palpation was the only pain measure significantly related to Achilles tendon structure (thickness: r =.20, p=0.007; CSA: r =.21, p=0.005). Pain on palpation remained a significant predictor of tendon thickness (b=0.03, p=0.002), CSA (b=0.04, p=0.003), and degree of thickening (b=0.02, p=0.028) in linear regression models.

Conclusion: Pain on palpation is a simple and important clinical measure that captures a unique aspect of the pain experience and relates to pathological Achilles tendon structural changes. This makes pain on palpation an important measure for the diagnosis and prognosis in those with midportion Achilles tendinopathy.

Level of evidence: 3.

Individualizing muscle strengthening is central to sports rehabilitation, yet clinicians often rely on isolated metrics such as peak torque or limb symmetry. These measures are informative but do not describe how force is expressed across contraction velocities, which is a key determinant of power production and high-velocity functional capacity. Force-velocity profiling provides a practical reasoning framework to classify deficits as force-oriented or velocity-oriented and to tailor exercise selection and loading accordingly. When high-velocity or high-power functional tasks are not yet feasible, torque data collected at multiple angular velocities using isokinetic dynamometry can provide a controlled basis for early assessment of muscle performance, provided these data are interpreted within a clinical reasoning framework. In this context, isokinetic force-velocity capacities do not replace functional testing; rather, their clinical interpretation can help plan and justify progression toward higher-velocity and more sport-specific exposures. The clinical value lies less in utilization of technology than in the interpretive lens of the testing results that links assessment to prescription. From an international perspective, this framework is adaptable across diverse practice settings and may improve coherence between assessment, strengthening prescription, and functional progression after injury.

The wrist joint is a common site of pain and injury due to either overuse or acute trauma. Many instances of wrist pain occur on the ulnar side of the wrist. This side of the wrist is commonly referred to as the "black box" of the wrist due to its small size and complex anatomy. Housed within the ulnar side of the wrist is the triangular fibrocartilage complex (TFCC). The TFCC is a complex of soft tissues that serves as a shock absorber and stabilizer of the distal radioulnar joint (DRUJ). This entire complex around the DRUJ and TFCC is composed of a central articular disc, a dorsal/volar radioulnar ligament, ulnar collateral ligament, and the extensor carpi ulnaris sheath. 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 bone. MSKUS is excellent at detecting changes in ligament composition and continuity. This manuscript will review the utility of MSKUS in evaluating TFCC and DRUJ injuries, including anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. Due to the small size and variety of structures in a confined space, diagnosing acute injury by physical examination is often difficult. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for patients with wrist injuries.

Background: Identifying movement dysfunction is critical for optimizing training and injury risk. While functional movement assessments like the Y-Balance Test (YBT) and the Landing Error Scoring System (LESS) are widely used, they require dedicated personnel, time, and testing space. The relationship between performance on movement assessments and the countermovement jump (CMJ) variables is unknown.

Hypothesis/purpose: The purpose of this study was to explore the relationship between CMJ force plate metrics and performance on the YBT and LESS in collegiate athletes. It was hypothesized that CMJ variables would differ between high- and low-performing athletes on the YBT and LESS.

Study design: Prospective observational cross-sectional study.

Methods: Male and female NCAA Division I athletes aged 18-21 years (n = 109) completed the YBT and LESS using standard protocols, and the CMJ on a validated portable force plate during the off-season as part of routine performance monitoring. Movement assessments independently stratified athletes into high- and low-performing groups. Group differences in CMJ metrics of jump height, Left/Right (L/R) peak propulsive force, landing stiffness, peak landing force, L/R average landing force, L/R landing impulse, reactive strength index modified (mRSI), and propulsive phase duration were analyzed using t-tests or Wilcoxon signed-rank tests.

Results: Athletes with LESS scores >5 demonstrated significantly greater landing stiffness (mean = -9757.73 ± 16231.15 N/m) compared to those scoring ≤5 (mean = -6555.38 ± 3515.67 N/m) (p = 0.01). Athletes with an anterior limb reach difference > 4 cm on the YBT had higher mRSI (p = 0.004), propulsive phase (p = 0.004), and peak landing force (p = 0.002).

Conclusion: Some CMJ metrics vary by performance on the YBT and LESS, offering insight into movement quality in collegiate athletes. While further research is needed to establish direct links to outcomes, these findings support CMJ testing as a practical, objective complement to traditional movement assessments.

Level of evidence: Level 3.

This correspondence addresses claims of novelty in the recently published article by Worst and Henderson (2026) regarding normative values for the single-leg bridge (SLB) endurance test. While the authors contribute valuable insights into clinician assessment accuracy, their assertion that normative SLB values for healthy young adults are currently "lacking" or "first" reported in 2026 overlooks foundational data published in 2021 (Lehecka et al.). This letter clarifies the methodological and demographic confluence between the Gluteal Endurance Measure-B (GEM-B) and the SLB test, noting that normative values established via electromyographic median frequency shifts and visual estimation have been available since 2021. Correcting the scientific record ensures accurate attribution and maintains the evidentiary lineage required for evidence-based practice and future meta-analyses.