International Journal of Sports Physical Therapy最新文献

Force plate vertical jump testing can identify persistent lower limb asymmetries after anterior cruciate ligament reconstruction (ACLR). Unfortunately, there is no consensus on which vertical jump task, nor the hundreds of available metric assessment combinations that are relevant to basketball athletes after ACLR. # Purpose The purpose of this study was to examine the jump performances of high school and collegiate male basketball athletes in the final stages of ACLR rehabilitation to 1) establish referenceable between-limb symmetry scores, and 2) identify metrics that best detect between-limb asymmetry during common vertical jump tasks. # Study Design Retrospective cohort examination # Methods Forty-nine male high school and collegiate basketball athletes who underwent primary ACLR were examined using a dual force plate system in the final stages rehabilitation. Participants were subdivided into two groups: athletes who exhibited above or below 90% isokinetic quadriceps peak torque limb symmetry index (LSI). Select jump metrics were collected from three jumping tasks: double-leg countermovement jump (DL-CMJ), single-leg countermovement jump (SL-CMJ), and single-leg repeat hop (SL-RH). Referenceable LSI jump scores were reported using descriptive analysis and compared between the two groups using independent samples t-tests. # Results Significant differences in LSI between the two groups were identified (p< 0.05) during the DL-CMJ: eccentric rate of force development (MD= -22.6), concentric impulse (MD= -22.4), concentric impulse 100ms (MD= -24.0), contact time (MD= -.43), and peak take-off force (MD= -12.7), and during the SL-RH: jump height (MD= -12.4) and flight time:contact time (MD= 13.3). No significant differences were found during SL-CMJ testing. # Conclusions In the final phases of ACLR rehabilitation, basketball athletes who exhibit quadriceps strength asymmetry also demonstrated greater asymmetry during double-leg and single-leg reactive jumping tasks but not during single-leg countermovement jumps suggesting the importance of a battery of jump tests to ensure adequate restoration of physical qualities required for the sport. # Level of Evidence Level 3.

Background: Psychological readiness after anterior cruciate ligament reconstruction (ACLR), as measured by the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, has become a critical factor in determining an athlete's ability to return to sport. While the ACL-RSI is widely used, the influence of the timing of its administration in relation to physical performance testing has not been studied.

Purpose/hypothesis: The primary aim of this study was to investigate the differences in ACL-RSI scores and subscale scores assessed up to one week before versus immediately after exposure to objective physical performance testing, but prior to reviewing the results with the athlete.

Study design: Prospective case series.

Methods: Fifty athletes recovering from ACLR participated in this study. The ACL-RSI questionnaire was administered within one week prior to and immediately after completing a return-to-sport physical performance testing battery. The testing included elements assessing maximum volitional force production, explosiveness, and hopping and landing ability. Changes in overall ACL-RSI scores and its subscales (emotions, confidence in performance, and risk appraisal) were analyzed.

Results: No significant differences were found in ACL-RSI scores pre- to post return to sport testing (-2.27, p=0.125). However, there was a significant decrease in the emotions subscale (-5.08, p=0.006), suggesting that physical testing may negatively impact emotional readiness. The confidence in performance and risk appraisal subscales did not show significant changes. Despite no statistical differences in ACL-RSI scores pre- to post return to sport testing, 20% of participants exhibited a change in ACL-RSI scores that exceeded the minimal clinically important difference (MCID), highlighting individual variability in psychological responses to testing.

Conclusion: The findings suggest that administering the ACL-RSI after physical performance testing may provide a more accurate assessment of some athletes' psychological readiness to return to sport. The significant reduction in the emotions subscale underscores the need for further research into the emotional impact of physical testing.

Level of evidence: 3b.

Background: The Star Excursion Balance Test (SEBT) is well recognized in both clinical and research settings as a reliable, valid, and responsive assessment. However, the SEBT is time consuming and inconvenient. To address this limitation, a new device called the Star Performer™ has been developed to improve the efficiency of SEBT.# PurposeTo investigate the test-retest reliability of Star Performer™ device and compare its validity to traditional SEBT methods.

Study design: Cross-sectional study.

Methods: Twenty-five subjects with lower extremity injuries participated in this study. Each subject performed the SEBT twice, with approximately seven days between tests. The Star Performer™ device and a tape measure were used to record three test trials for each test direction with the average of the three reach distances being used for analysis. Test-retest reliability was evaluated by calculating the intra-class correlation coefficients (ICC 3,1) between the average reaching distance for each SEBT direction across the two testing sessions. To assess the validity of the Star Performer™ device, the averaged reaching distance for each SEBT direction was compared with the measurements obtained from the tape measure.

Results: Seventeen females (68%) and eight males (32%) with lower extremity injuries (mean age= 23.6 years, SD=3.9, range from 19-35) participated. The Star Performer™ demonstrated excellent test-retest reliability, with ICC 3,1 values ranging from 0.85 to 0.93 for the eight SEBT directions. The minimal detectable change at the 95% confidence level (MDC95) ranged from 2.56 to 5.37% for the eight directions. The Pearson correlation coefficients between the Star Performer™ and tape measure recordings ranged from 0.90 to 0.94 for the eight directions.

Conclusion: This study provides evidence supporting the test-retest reliability and validity of the Star Performer™ for assessing SEBT performance. These findings suggest that Star Performer™ offers a precise and efficient approach to evaluate SEBT performance in individuals with lower extremity injuries.

Level of evidence: Level 3b.

Anterior cruciate ligament (ACL) injuries are a significant injury for athletes participating in cutting and pivoting sports requiring lengthy rehabilitation. Athletes undergoing anterior cruciate ligament reconstruction (ACLR) continue to be limited in the ability to return to their sport and to their prior level of performance despite undergoing postoperative rehabilitation. For those that do return to sport, re-injury rates remain high (~20%). Current rehabilitation guidelines address knee joint impairments and neurocognitive/sensorimotor factors, but do not address how the triceps surae muscles are also affected following ACL injury. This clinical commentary aims to examine the potential mechanisms surrounding the contributions of the gastrocnemius and soleus musculature on tibial kinematics, the effects ACL injury has on the calf musculature, and the potential clinical implications for prevention of subsequent injuries in the post ACLR rehabilitation framework. Sex differences and rehab considerations across the pre- and post-surgical ACLR timeline are also addressed. Level of Evidence: 5.

Background: While suspension and vibration training offer several benefits across various body regions, evidence for injury rehab remains limited.

Hypothesis/purpose: The purpose of this case series was to examine the effect of seven weeks of strength training using a novel vibration device (superimposed vibration with 40 Hz frequency) with an attached suspension strap on two subjects recovering from a shoulder subluxation.

Methods: Two physically active men who had sustained prior non-dominant subluxation underwent seven weeks of strength training using a suspension device operating at 40 Hz. An intervention comprising six exercises was performed twice weekly for seven weeks, divided into two blocks of three exercises: Block 1) suspended chest fly, inverted row, shoulder taps; Block 2) elbow flexion, standing overhead triceps extension, and the side plank. They performed three sets of eight repetitions in each block, resting 30 seconds between exercises and three minutes between blocks. Eight touches were performed per arm during the shoulder taps exercise, and the side plank was held for 25 seconds on each side. In addition to assessments of range of motion (ROM) and strength, the Y-Balance Test-Upper Quarter (YBT-UQ) and Closed Kinetic Chain Upper Extremity Stability Test (CKUEST) tests were performed to glenohumeral stability, and strength. Results: The greatest ROM improvements (~50%) were found in the internal rotation (IR) compared to a 5% in flexion and 20% in external rotation (ER). Glenohumeral stability increased in all the positions of the YBT-UQ for the injured arm (5% to 33% depending on the position), and the CKUEST (10-20%). Additionally, significant gains were seen in the injured arm during isometric push and pull tests (around 10%), but no differences in the dynamic strength in the bench press exercise force velocity profile.

Conclusions: Using vibration-enhanced suspension training improved the joint stability and strength of the two subjects without adverse effects. Additional research is needed to confirm these findings.

Level of evidence: 4.

Background and purpose: Cervical total disc replacement (CTDR) was developed to decompress nervous structures, preserve spinal biomechanics, and reduce postoperative complications such as nonunion or fracture. There is no published literature regarding the optimal content, timing and duration of postoperative physical therapy (PT) for CTDR. Therefore, the purpose of this case report is to describe the postoperative PT management and one-year outcomes of a subject with CTDR as it relates to pain, function and quality of life.

Case description: A 37-year-old male and Brazilian Jiu Jitsu athlete with cervical radiculopathy underwent a C5-C6 and C6-C7 discectomy with CTDR. The subject attended PT for 14 sessions across 16 weeks. Interventions included manual therapy (soft tissue and joint mobilization), therapeutic exercise targeting cervical spine, thoracic spine and upper extremity mobility and strength, and weightlifting body mechanics education. Radiographic confirmation of prosthesis placement and healing was monitored at postoperative weeks six and 12. The PT program was designed and progressed according to tissue healing timelines, subject response, clinical reasoning, and sport-specific demands.

Outcomes: Improvements were noted with Neck Disability Index (14% to 0%), Patient Specific Functional Scale (3.4/10 to 10/10), Short Form-12 Physical Score (+5.4) and Mental Score (+25.7), and Numeric Pain Rating Scale (2/10 to 0/10). Cervical active range of motion (in degrees) improved in all motions, and deep neck flexor endurance from 5-35 seconds.

Discussion: A multimodal PT program following CTDR based on tissue healing timelines and clinical reasoning improved pain, function and quality of life up to one year postoperatively without adverse effects in this athlete. # LEVEL OF EVIDENCE 4.

Background: Thigh circumference is a commonly gathered clinical data point intended to measure muscular atrophy. However, there is limited research examining whether thigh bulk, as observed through circumferential limb measurement, is meaningfully associated with quadriceps muscle strength.

Purpose: To retrospectively assess if a correlation exists between side-to-side difference (SSD) of thigh bulk and limb symmetry index (LSI) with quadriceps isometric strength testing.

Study design: A retrospective, case control study.

Methods: Sixty-seven patients who underwent ligamentous reconstruction completed testing during a six-month post-operative follow-up visit (6.47 +/- 0.79 month). Testing included both clinical and strength measurements. Clinical measurements included side to side thigh bulk circumference difference (SSD) and strength testing included calculated quadriceps strength limb symmetry index (LSI) obtained from isometric testing at 90 degrees of knee flexion performed on an isokinetic dynamometer. Pearson's correlation coefficients were used to assess the relationships between variables.

Results: The principal findings were a mean thigh circumference difference of 2.53 + 1.54 cm and mean quadriceps LSI at time of testing of 66.88 + 16.93%. A moderate, positive relationship was found between thigh circumference difference and the quadriceps LSI (r= 0.36, r2= 0.13, p = 0.003).

Conclusion: A moderate positive correlation between circumference and isometric strength exists that may help clinicians monitor strength differences side to side. Thigh circumference only accounts for approximately ~13% of all factors that influence quadriceps LSI, therefore it is appropriate to incorporate a battery of different tests and measures to properly assess muscular strength following knee surgery.

Level of evidence: Level 3 Evidence.

Introduction: Glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM) deficit, and weakness of the rotator cuff have been determined to be potential risk factors for the development of shoulder and elbow injuries in the overhead thrower. The causes for these deficiencies are multifactorial and the ability to identify and correct those deficits could decrease the potential for injury. Therefore, the purpose of this case report was to investigate the immediate effects of a muscle energy technique (MET) on shoulder internal rotation ROM and external rotation strength in the throwing shoulder of an overhead thrower.

Case description: The subject of this case report was a 20-year-old collegiate baseball pitcher without any reported previous injury that presented with a loss of passive shoulder internal rotation at 90 degrees of abduction, a deficit in TRM, and weakness of the external rotators as determined by handheld dynamometry. The athlete was identified during a pre-sport screening for overhead throwers. Following the assessment, a MET was performed for shoulder internal rotation in a side-lying position.

Outcome: The athlete demonstrated an immediate 38-degree improvement in shoulder internal rotation motion, reduction in TRM deficit from 42 degrees to 4 degrees, and 7.8% increase in shoulder external rotation strength.

Discussion: It is not uncommon for symptomatic and asymptomatic overhead throwers to present with GIRD, TRM deficit, and rotator cuff weakness. The ability to improve these deficits following the application of a MET could imply that the deficits are linked. Previous studies have identified different methods that improve internal rotation ROM but have not documented possible related outcomes in external rotation strength. Future research should examine the potential mechanism for such a response to the MET, and if these changes have a lasting effect, as only short-term effects were examined.

Level of evidence: 4.

Background: Assessing lower extremity strength and performance is common practice in sports medicine. Sport-specific demands could impact the amount of leg strength asymmetry between the dominant and non-dominant leg present in athletes.

Hypothesis/purpose: The purpose of this pilot study was to explore the amount of lower limb strength asymmetry between the dominant and non-dominant of female collegiate athletes across different sports.

Study design: Case control study.

Methods: A total of 43 female Division I collegiate athletes from soccer, tennis, and volleyball teams participated in the study. Subjects were separated into groups based on participation in a jumping sport (volleyball) versus a cutting sport (soccer and tennis). Differences in concentric quadriceps peak torque between the dominant and non-dominant legs at 60 deg/sec, measured using the Biodex System 3 isokinetic dynamometer, were compared across groups. Athletes of each sport type were classified as "dominant stronger", "equal", or "non-dominant stronger" based on the differences between leg strength using a cut-off value of a difference of 10ft-lbs of torque. Odds ratios were calculated to determine the association between sport exposure and quadriceps strength on the dominant side.

Results: Jumping athletes were 30 times (OR=29.96 (CI 95%, 1.56 - 577.25) more likely than cutting athletes to have a stronger dominant quadriceps. In jumping athletes, the participants were distributed almost evenly across the "dominant stronger", "non-dominant stronger", and "equal" groups. In cutting athletes, 76.9% fell into the "equal" category, while the remaining 23.1% fell into the "non-dominant stronger" category.

Conclusion: Female collegiate jumping athletes were much more likely to have a stronger quadriceps on the dominant vs non-dominant leg than were cutting athletes. This information can be used to help develop specific strength and conditioning and rehabilitative programs for female athletes.

Level of evidence: Level 3.

Background: A sedentary lifestyle contributes to hip flexor tightness. Some evidence suggests that tight hip flexors may contribute to impairments in gluteal function.

Purpose: The purpose of this study was to determine the effects of a daily lunge-and-reach stretching program on hip flexor length and gluteus maximus strength, power, and endurance in healthy college-aged adults.

Study design: Cohort Study.

Methods: Twenty-three participants with hip flexor tightness (15 females, 8 males; average age 24.0 ± 2.58 years) totaling 46 limbs were tested. Twelve participants were randomly assigned to the experimental group, while the remaining eleven were placed in the control group. Hip flexor length was measured with the Modified Thomas Test using an inclinometer. Gluteal power was measured on each lower extremity using a single-leg broad jump for distance with a tape measure. Gluteal strength was measured with prone hip extension using a handheld dynamometer and luggage scale. Gluteal endurance was measured with a single-leg bridge using a stopwatch. Participants in the intervention group performed five minutes of a lunge-and-reach stretch daily for six weeks.

Results: Statistically significant changes were found for the Modified Thomas Test (mean change 5.92 ± 3.73 deg, p=0.01) and single-leg broad jump for distance (mean change 12.39 ± 11.23 cm, p=0.02) for the intervention group. No significant change was found for gluteal strength or single-leg bridge endurance (p=0.23 and p=0.26, respectively) for the intervention group. All measurements demonstrated high reliability (ICC=0.92-0.99).

Conclusion: These results suggest that the lunge-and-reach stretch can be used to improve hip flexor length and gluteal power in a young, healthy population. Clinicians, coaches, and athletes may find these improvements beneficial for rehabilitation or performance.

Level of evidence: Level 3.