International Journal of Sports Physical Therapy最新文献

Background: Some individuals have exercise-induced lower leg pain (ELP) caused by a chronic exertional compartment syndrome (CECS). As intracompartmental muscle pressure measurements are invasive with suboptimal test characteristics, other diagnostic tools are needed. Recently, ultrasound-based muscle compartment thickness analysis at 10mmHg (d10) and 80mmHg (d80) external pressure was introduced for this purpose. The difference in compartment thickness at these two external pressures induced by the study device is used to calculate muscle compressibility, a possible marker for CECS.

Purpose: The purpose of this study was to investigate the reliability of a novel ultrasound compressibility technique using two distinct internal landmarks at the lower leg in a diverse group of asymptomatic adults.

Study design: Cross-sectional study.

Methods: Healthy volunteers (n=35; 21 female; median age 40 years, range 19-72; BMI 24.1 kg/m2, range 18.3-31.6) not having ELP underwent serial compressibility measurements (n=1678) of both legs by three observers at the tibialis anterior (TA) using the interosseous membrane (IM) and transition zone IM to tibial bone (TZIT) as internal landmarks. Inter- and intra-observer reliability was calculated for values of d10, d80 and compressibility using intraclass correlations (ICC).

Results: TA compartments are less compressible using the IM landmark compared to the TZIT landmark (10.5% vs 12.5%; p<0.001). Inter-observer ICC for IM was always higher (d10 0.85; d80 0.82; compressibility 0.51) than for TZIT (d10 0.65; d80 0.53; compressibility 0.20). The intra-observer reliability for d10 and d80 was excellent (ICC>0.90) for all three observers. ICC of compressibility varied among observers and ranged from 0.76 to 0.48, with higher ICCs demonstrated for IM compared to TZIT.

Conclusion: Ultrasound based anterior tibial muscle compressibility measurements have moderate inter-observer reliability and excellent intra-observer reliability if the interosseous membrane is used as internal landmark. Future studies are aimed to test muscle compressibility after exercise and in CECS.

Level of evidence: Level 3.

Background: Concussion in children is a significant public health burden in the United States with 2.3 million children under the age of 17 years sustaining a concussion in 2022 alone. Children post-concussion experience a wide range of symptoms of vestibular dysfunction. Vestibular rehabilitation therapy (VRT) has been shown to substantially decrease dizziness and improve gait and balance function in adults post-concussion, but limited information is available for children. Purpose: The purpose of this systematic review was to determine the effectiveness of VRT on improving vestibular function, postural control, and gait in children post-concussion.

Study design: Systematic review.

Methods: An electronic search of MEDLINE and CINAHL was conducted in October 2022 and later updated in April 2024 using MeSH terms and keywords related to vestibular rehabilitation, concussion, and children. Quality appraisal was conducted independently by two reviewers using the Joanna Briggs Institute checklist, the Critical Appraisal Skills Programme checklist and Cochrane risk of bias assessment tool. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were utilized for screening and data extraction.

Results: Overall, twelve studies (three randomized controlled trials, five cohort studies, two case series and two case reports) were included in the review. The Dizziness Handicap Inventory (DHI) was the most frequently utilized measure (five studies). Three studies reported a statistically significant improvement in DHI (change scores = 19-25, p < 0.05), gait speed (F = 38.3, p < 0.001), Balance Error Scoring System (BESS) (change score percentage 12.1 - 52%, p < 0.01), and Activities-specific Balance Confidence (ABC) scale (change = 20-29 points, p <0.01).

Conclusion: VRT shows promise and may result in symptom improvements in children post-concussion when used as part of a multimodal intervention plan. Further research with larger samples is recommended to make informed decisions about dosage and long-term functional outcomes in children post-concussion.

Level of evidence: 3.

Background: Weakness of the rotator cuff has been reported in patients with subacromial impingement syndrome (SIS). A novel therapeutic approach proposes adding exercises for the core musculature to aid in functional recovery in these patients.

Purpose: The aim of this study was to assess the short-term effects of adding a core exercise program to supervised physiotherapy on improve lateral rotator strength and functional outcomes in patients with SIS.

Study design: A pre-post single-group study.

Methods: A total of 47 participants with SIS were recruited. All patients were treated with five weeks of supervised physiotherapy plus a core exercise program. The primary outcomes were isometric lateral rotator strength and grip strength, measured with a dynamometer. Secondary outcomes included muscular endurance assessed with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), shoulder function with the Constant-Murley (CM) questionnaire, and pain intensity reported using the Visual Analog Scale (VAS). Need a brief statement of statistical approach.

Results: At end of the five week intervention, isometric lateral rotator strength showed an increase of 9.2 kg (d = 2.1; p < 0.001) and grip strength an increase of 10.6 kg (d = 2.4; p < 0.001). The CKCUEST showed an increase of 5.6 repetitions (d = 3.7; p < 0.001), the CM questionnaire showed an increase of 30.3 points (d = 4.9; p < 0.001) and the VAS showed a decrease of 3.9 cm (d = 6.0; p < 0.001). All outcomes showed large effect sizes and statistically significant differences.

Conclusion: In the short term, adding a core exercise program to supervised physiotherapy showed statistically and clinically significant differences in lateral rotator strength and functional outcomes in patients with SIS.

Level of evidence: Level 3.

Background: Achilles tendinopathy is a common overuse condition that can become persistent despite conservative treatment. Sensitization of both the peripheral and central nervous systems may contribute to the persistent pain. Both exercise and electrical stimulation have the potential to modulate the nervous system's sensitivity to painful stimuli.

Hypothesis/purpose: The purpose of this study was to describe the changes in pain sensitivity and self-reported function in runners with chronic Achilles tendon pain following sequential treatment with noxious electrical stimulation (NxES) and eccentric plantarflexion exercise.

Study design: Single group, repeated measures design.

Methods: Sixteen participants with chronic Achilles tendinopathy completed the Lower Extremity Functional Scale (LEFS) and the Victorian Institute of Sport Assessment-Achilles scale (VISA-A) and quantitative sensory tests (pressure pain threshold, heat temporal summation, and heat pain threshold) at baseline, one week, seven weeks, and then at a one month post intervention follow-up. The NxES was applied for one week, then followed by plantarflexion eccentric exercise for six weeks. Changes across timepoints were assessed using repeated measures ANOVA and post hoc analysis to describe differences. Hedges g effect sizes were also calculated.

Results: There was a significant improvement in LEFS (p < 0.001) and VISA-A (p < 0.001) from baseline to one month follow-up, with a mean change of 9.6 ± 7.7 and 19.4 ± 17.7 points respectively. Pressure pain threshold of the involved Achilles tendon increased over time (p < 0.001) with significant improvements after NxES application (p = 0.002) and after six weeks of eccentric exercise (p < 0.001). There were significant improvements from baseline to one month follow-up for heat temporal summation (p = 0.001) and heat pain threshold ( p < 0.001).

Conclusions: For individuals with chronic Achilles tendinopathy, a sequential treatment of NxES followed by eccentric exercise resulted in a clinically significant improvement in self-reported pain and function. During the first week of treatment there was a reduction in mechanical hyperalgesia during the NxES-only phase, while a large reduction in primary heat hyperalgesia and additional desensitization to mechanical pain occurred during the eccentric training phase of treatment.

Level of evidence: 2b.

Background: Meniscus injuries often accompany anterior cruciate ligament (ACL) tears. However, little is known about how different surgical approaches to treat concomitant meniscus injuries impact hop performance after ACL reconstruction. Purpose: The purpose of this study was to compare hop test inter-limb symmetry for patients who had undergone ACL reconstruction without an associated meniscal surgery, patients who had undergone ACL reconstruction with a meniscus repair, and patients who had undergone ACL reconstruction with a partial meniscectomy.

Study design: Cross-sectional study.

Methods: Hop test data collected at the time of return-to-sport testing (average of 6.4 ± 1.4 months after surgery) was extracted from electronic medical records for 192 patients who had undergone ACL reconstruction. Of these patients, 102 had undergone an isolated ACL reconstruction, 60 had undergone an ACL reconstruction along with a meniscus repair, and 30 had undergone an ACL reconstruction along with a partial meniscectomy. Analysis of variance was used to compare limb symmetry indices for the single- and triple-hop tests. These limb symmetry indices reflected the ratio of the hop distance for the involved limb relative to the uninvolved limb, expressed as a percentage.

Results: The sample was comprised of 100 males and 92 females. Their average age was 20.6 ± 8.2 years. There were significant differences among the groups for the single-hop test (p = 0.031) and triple-hop test (p = 0.024) limb symmetry indices. For both tests, the patients who had undergone ACL reconstruction with a partial meniscectomy tended to exhibit greater deficits in hop performance for their involved limb (relative to their uninvolved limb), compared to those without a meniscal injury and those who had undergone meniscus repair.

Conclusions: The results of this study suggest that patients who undergo ACL reconstruction along with a partial meniscectomy tend to experience less complete and/or delayed recovery of involved-limb hop performance, which could reflect more persistent deficits in lower body power.

Level of evidence: 3.

Background: While one-legged and two-legged bodyweight squats on unstable and stable surfaces are commonly used during patellofemoral rehabilitation, patellofemoral loading during these exercises is unknown. Understanding how patellofemoral force and stress magnitudes affects different squat variations will aid clinicians in determining how and when to prescribe and progress these squatting types of exercises in patients with patellofemoral pain.

Hypothesis/purpose: To quantify patellofemoral force and stress between two squat type variations (BOSU squat versus floor squat) and between two leg variations (one-legged squat versus two-legged squat). It was hypothesized that patellofemoral force and stress would be greater in BOSU squat than floor-squat, and greater in one-legged squat than two-legged squat.

Study design: Controlled laboratory biomechanical, repeated-measures, counterbalanced design.

Methods: Sixteen healthy participants performed one-legged and two-legged BOSU and floor squats. Kinematic and ground-reaction force data were used to calculate resultant knee force and torque using inverse-dynamics, with electromyographic data employed in a knee muscle model to predict resultant knee force and torque at every 10° between 10°-100° knee-angles during the squat-descent and squat-ascent. Repeated-measures 2-way ANOVA (p < 0.01) was employed for statistical analyses.

Results: Collapsed across one-legged and two-legged conditions, patellofemoral joint force and stress were significantly greater during floor squats than BOSU squats at 40°, 50°, and 70° knee-angles during squat descent and 60° and 50° knee-angles during squat ascent. Collapsed across BOSU and floor squats, patellofemoral joint force and stress were significantly greater for one-legged squats than two-legged squats at all knee-angles. Significant interactions between squat types and leg conditions were found at 30°, 40°, 50°, 60°, and 100° knee-angles during squat-descent, and 100°, 90°, 80°, and 70° knee-angles during squat-ascent, with patellofemoral joint force and stress significantly greater in two-legged floor-squat than two-legged BOSU squat, but no significant differences between one-legged floor-squat and one-legged BOSU squat.

Conclusions: Squatting progression employing lower to higher patellofemoral loading over time during PFP rehabilitation may be considered: 1) two-legged BOSU squats at lower knee angles (0° - 50°); 2) two-legged floor squats at lower knee angles (0° - 50°); 3) one-legged BOSU and floor squats at lower knee angles (0° - 50°); 4) two-legged BOSU squats at lower and higher knee angles (0° - 100°); 5) two-legged floor squats at lower and higher knee angles (0° - 100°); 6) one-legged BOSU and floor squats at lower and higher knee angles (0° - 100°).

Level of evidence: 2.

Background: The use of portable hand-held dynamometers is increasing in popularity due to their ease of use in different clinical settings, convenient size, portability, and overall affordability. Reported reliability for external fixation and rater-stabilized hand-held dynamometry (HHD) strength measurements have been found to be 'good' to 'excellent'. Inconsistent agreement has been found between the two stabilization methods and isokinetic HHD testing.

Purpose / hypothesis: Determine the reliability and agreement of HHD measurements in three different rater test positions against three different mechanically produced force magnitudes. The study compared measurements obtained by rater-stabilization to external fixation methods.

Study design: Intra-rater and inter-rater reliability study.

Methods: Ten raters took measurements in three different rater test positions against three different force magnitudes created by an external force. Raters were blinded to the randomized force magnitudes. The rater's measurements were compared to measurements taken against an external fixation stabilization device. To establish reliability, Intraclass Correlation Coefficient (ICC), and Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) were used. To establish agreement, error rates between the rater-stabilized and external fixation stabilization measurements were calculated.

Results: ICC's were found to be 'excellent' at .97 and above. The relative SEM ranged from 0.2% to 0.9 % and the relative MDC ranged from 0.7% to 2.8%. The overall error rate was 15.5% and was influenced by force magnitude.

Conclusion: The use of standardized rater test positions resulted in 'excellent' intra-rater, inter-rater reliability, low SEM, and low MDC for rater-stabilized HHD measurements. A systematic error was observed, with rater-stabilized measurements resulting in higher values compared with values obtained with the external fixation method.

Level of evidence: 3.

Background: Hamstrings and quadriceps strength recovery and restoration of the hamstrings-to-quadriceps ratio (H/Q ratio) is a major concern after anterior cruciate ligament reconstruction (ACLR). Recently, moment-angle profiles and angle-specific H/Q ratios are receiving increasing interest.

Purpose: The first objective of this study was to investigate moment-angle profiles and angle-specific H/Q ratio profiles in athletes with ACLR at the time of RTS. The second objective of this study was to assess whether strength asymmetries identified at the time of RTS, persist after six months.

Study design: Case-Control study.

Methods: Twenty athletes who had undergone ACLR performed isokinetic strength tests for concentric knee flexion and extension (60°/s) at RTS, and three and six months later. Twenty controls were tested once. T-tests were used to compare strength differences between 1) ACLR athletes and controls and 2) the injured and uninjured leg of the ACLR athletes. Finally, to assess strength deficits over time, two-way ANOVAs were used.

Results: Angle-specific analyses and peak moments showed lower hamstrings strength in the injured leg of ACLR athletes compared to their uninjured leg at RTS. Furthermore, angle-specific analyses showed a lower hamstrings strength and H/Q ratio in the injured leg compared to controls at larger knee flexion angles. The latter deficit was not identified with a peak-based analysis. The asymmetries identified at RTS did not change over the six months following RTS.

Conclusions: Athletes with ACLR show strength deficits and asymmetries that persist even six months after RTS. As some asymmetries may go undetected by peak-based analyses, angle-specific analyses are recommended.

Level of evidence: Level 3b.

Observational evaluation of arm elevation is a routine part of the examination of patients with shoulder pain and dysfunction. However, the interdependency of the glenohumeral and scapulothoracic joints during arm elevation presents a challenge for clinicians when attempting to characterize movement impairments and underlying causes. Given that identification of movement impairments related to the scapulothoracic joint (i.e. scapular winging or excessive scapular elevation) are more easily observed compared to movement faults at the glenohumeral joint (i.e. superior or anterior translation of the humeral head) an inherent bias may exist in which clinicians prioritize movement impairments and associated physical impairments at the scapulothoracic joint in developing a treatment plan. Interpreting the cause(s) of abnormal scapulothoracic motion without considering the potential influence of the glenohumeral joint (and vice-versa) may lead to faulty clinical reasoning when developing a plan of care. The purpose of this clinical commentary is to highlight the potential impact of faulty glenohumeral joint mechanics as being contributory to scapulothoracic joint kinematics. We first review the normal kinematics and muscular actions associated with typical arm elevation and then discuss how impairments at the glenohumeral joint may be contributory to faulty scapulothoracic motion. Specifically, we address movement faults characterized by excessive motion of the scapula.

Level of evidence: 5.

Background: An automated pupillometer is a handheld device used to stimulate the pupillary light response (PLR) and track the entirety of the response from constriction to dilation. Pupillometers provide objective data that clinicians can use to identify and assess brain injury. The validity of these devices has been previously established; however, the inter-rater and inter-trial reliability are unknown.

Purpose: The purpose of this study was to assess the inter-rater and inter-trial reliability of the NeurOptics PLR-3000 pupillometer device in measuring pupil size changes, constriction velocities, and dilation velocities. The authors hypothesized that inter-rater and inter-trial reliability would have intraclass correlation coefficients (ICC) greater than or equal to 0.70 for all PLR parameters.

Study: Design: Observational, reliability study Methods: Forty-eight healthy adults (age 18-40 years) without a history of neurological injury, optical surgery, or cognitive impairment participated. Two independent raters used the NeurOptics PLR-3000 to measure PLR parameters in the left and right eyes of each subject. Data for the average and individual trials of each PLR parameter were used to determine inter-rater and inter-trial reliability, respectively. Inter-rater and inter-trial reliability was evaluated using descriptive statistics, ICC, the standard error of measurement, Bland-Altman plots, and the minimal detectable change.

Results: Seven out of eight NeurOptics 3000-PLR parameters demonstrated moderate-to-excellent inter-rater (ICC range 0.72-0.96) and good-to-excellent inter-trial reliability (ICC range 0.76-0.98). The 75% recovery time parameter exhibited moderate inter-rater (ICC range 0.64-0.67) and poor-to-moderate inter-trial (ICC range 0.41-0.65) reliability.

Conclusion: The NeurOptics 3000-PLR demonstrated acceptable reliability in measuring initial and end pupil size, constriction and dilation velocity, and latency to change between different users and trials. However, the device exhibited unacceptable reliability when measuring the time to 75% pupil size recovery. The device can be used in detecting and monitoring brain injury but should be limited to reliable measures only.