International Journal of Sports Physical Therapy最新文献

Background: Periacetabular osteotomy (PAO) surgery provides better coverage of the femoral head and alleviates symptoms of acetabular dysplasia. While guidelines on rehabilitation following PAO exist, these guidelines may not sufficiently address the challenges and opportunities in providing rehabilitation for patients with diverse needs and goals in various healthcare contexts.

Purpose: The purpose was to investigate the perceived challenges and opportunities of various post-PAO rehabilitation approaches from the perspectives of physiotherapists in Denmark and Australia. Study design: Qualitative study.

Methods: A hermeneutic, phenomenological approach and semi-structured interviews were applied to explore the perspectives of 18 physiotherapists (7 males), aged 29-63 years, who rehabilitate patients with acetabular dysplasia following PAO. To ensure diversity in the characteristics of physiotherapists, purposeful sampling based on age and sex was employed. The interviews were coded and analyzed using inductive content analysis.

Results: The analysis revealed three themes: "Identifying crucial factors for successful recovery", "Managing the recovery process through targeted rehabilitation", and "Building a trustworthy relationship". Several subthemes were identified, showing consistent patterns across countries. However, the Australian physiotherapists focused more on returning to sport and related milestones and providing structure-specific exercises. In contrast, the Danish physiotherapists emphasized addressing socioeconomic backgrounds and vulnerability among their patients.

Conclusion: The physiotherapists involved in the rehabilitation of patients with acetabular dysplasia shared common perspectives regarding post-PAO rehabilitation. However, the Australians prioritized returning to sport, while the Danes emphasized socio-economic background. This indicates an opportunity to leverage these insights by focusing on tailored rehabilitation strategies in future initiatives that accommodate patients' needs within their specific healthcare contexts, ultimately enhancing recovery outcomes.

Level of evidence: Not applicable.

Background: Ulnar collateral ligament (UCL) injuries are common among javelin throwers and surgical intervention is the preferred treatment method. Universally accepted javelin-specific return-to-sport (RTS) guidelines would benefit healthcare providers in returning athletes safely to the sport.

Purpose: To systematically assess the current literature for RTS criteria and identify gaps and opportunities for developing javelin-specific return to throwing (RTT) and RTS recommendations.

Study design: Systematic review.

Methods: A Boolean search related to javelin, UCL surgery, RTS was performed using PubMed/Medline, ProQuest, PEDro, Scopus, CINAHL, Cochrane, EMBASE, and SPORTDiscus databases. Studies published between 2000, and May 2024 were included if they had a population of javelin athletes of any level of competition who underwent UCL reconstruction (UCLR) with a minimum follow-up of one year.

Results: Four studies met inclusion criteria for this review with a total population of 34 athletes (mean age, all studies: 19.7 years) and an average follow-up period of 3.8 years for all studies. Of the 34 athletes, 82% returned to any level of play at an average of 11.2 months post-surgery, with 70.1% returning to their previous level of competition. Only one study provided a specific RTT program, which included stepwise progressions for number, effort, quality, and distance for throws and javelin weights used for each program phase.

Conclusion: This review found no studies providing guidelines for RTT/RTS criteria for javelin athletes following UCLR that emphasized objective measures of rehabilitation progress and completion. Further research on post-surgical physical function and subsequent programming tailored to the demands of javelin athletes is needed to guide safe return to sport.

Level of evidence: 3a.

Background: Given the high incidence of shoulder injuries among quarterbacks due to the repetitive stress of the overhead throwing motion, there is a need for targeted, sport-specific assessments that reflect the functional demands of throwing. The Athletic Shoulder (ASH) test, previously validated in rugby and baseball populations, offers a potential solution for upper extremity strength assessment in football quarterbacks. The primary purpose of this case series was to explore the feasibility of conducting the ASH test as a method for evaluating upper extremity strength in overhead athletes, specifically collegiate quarterbacks.

Study design: Case series.

Methods: Three NCAA Division I quarterbacks participated in weekly ASH testing over a nine-week period. Peak isometric force, peak force normalized to body weight, and limb symmetry indices were measured in the shoulder "Y" and "T" positions using portable force plates. Testing was completed pre-practice on non-game days to minimize fatigue effects and maintain consistency.

Results: The dominant shoulder consistently produced greater peak force than the non-dominant side in both Y and T positions. The mean dominant-to-non-dominant limb symmetry index was 1.13 in the Y position and 1.14 in the T position. Within limbs, peak force was greater in the Y position than in the T position. In both positions and in both arms, athletes generated at least 14% of their body weight in force on average.

Conclusion: These findings can provide insight into strength asymmetries and functional performance benchmarks, enabling strength coaches, athletic trainers, and rehabilitation professionals to fine-tune training and rehabilitation programs. Incorporating the ASH test into a standardized assessment battery may enhance the ability to evaluate an athlete's readiness to train or compete, promoting a proactive approach to performance optimization and injury prevention. Its utility and actionable metrics make the ASH test a practical tool for in-season monitoring, allowing practitioners to make informed, data-driven adjustments throughout the season.

Level of evidence: Level 4.

Background: Ambidextrous baseball pitchers are a rare phenomenon and present unique challenges in performance optimization and injury mitigation. Biomechanical and clinical analyses are fundamental to understanding performance adaptations and injury risks in developing athletes.

Purpose: The purpose of this case report is to describe key biomechanical and clinical differences between the dominant and nondominant throwing arms of a youth ambidextrous baseball pitcher across three timepoints using a multidisciplinary approach. The authors hypothesized that both age-related changes and arm-to-arm differences would be observed in the athlete's anthropometric and biomechanical measurements.

Study design: Case Report.

Methods: The athlete was a youth ambidextrous baseball pitcher who underwent voluntary pitching evaluations at ages 11, 12, and 14, while actively competing in organized youth baseball. The athlete first completed a clinical analysis, consisting of a passive range of motion assessment of shoulder internal and external rotation, hip internal rotation, and hamstring flexibility. Then the athlete completed a biomechanical analysis consisting of 3D motion capture to acquire kinematic and kinetic data of both throwing arms.

Results: The athlete demonstrated a progressive decline in total shoulder arc of motion bilaterally, with the greatest reduction observed on the nondominant side by age 14. Biomechanical data showed improvement in trunk rotation (>30°) and shoulder abduction angles, aligning with recommended values. However, shoulder distraction force and elbow varus torque increased over time, especially by the third evaluation, potentially reflecting increased pitch velocity and musculoskeletal loading.

Conclusion: Few studies have examined side-to-side biomechanical and clinical differences in ambidextrous pitchers. This case highlights changes over time that may reflect developmental adaptations, emphasizing the value of regular monitoring to identify asymmetries and manage injury risk.

Level of evidence: 4.

Background: Previous studies have shown that a lower running cadence (<170 steps/min) increases the risk of injury in runners. However, the immediate effect of increasing running speed on running cadence and ground reaction forces in experienced runners has not been well studied.

Purpose/hypothesis: The purpose of this study was to examine the immediate effect of running speed on running cadence and ground reaction forces in a sample of experienced runners.

Study design: Cross-sectional study.

Methods: Thirty runners ages 21-49 (11 female, 19 male) consented to participate. Inclusion criteria included running at least 24 km (15 miles) per week for the past year, and no running-related injury in the prior three months. Subjects completed a 6-minute acclimatization to running on an instrumented treadmill, during which they identified their preferred training pace. After a short break, each runner then ran at seven predetermined speeds in the order as listed: 2.68 m/s, 2.82 m/s, 2.98 m/s, 3.35 m/s, 3.58 m/s, and 3.83 m/sec. Participants ran for 90 seconds at each of the speeds and during the final 30 seconds of each running bout, cadence was counted and ground reaction forces were recorded. Ground reaction forces measured included overall peak vertical force, vertical impact peak, vertical average loading rate, peak braking force, and braking impulse. Temporospatial and ground reaction forces were analyzed using repeated measures general linear model. Kinetic data from left and right limbs were compared using paired t-tests.

Results: No significant differences existed between the right and left limb force data so only the left limb data are reported. Mean cadence increased from 169 steps/min at 2.68 m/s to 178 steps/min (p<0.001) at 3.83 m/s. All ground reaction force variables also increased significantly (p<0.001) from the slow to fast speed. Both stance time and step time decreased significantly (p<0.001) from the slow to the fast speed.

Conclusions: The results of this study demonstrate that in a group of experienced runners, as running speed increases, both cadence and ground reaction forces increase. Concurrently, both stance time and step time decreased.

Level of evidence: Level 3.

Background: Cervical intervertebral disc (IVD) height can be used to indirectly measure of IVD hydration status. Intervertebral disc dehydration results in height loss, which can contribute to degenerative disc disease. There is need for in situ cervical IVD ultrasound assessment to better understand spinal health.

Purpose: To determine reliability and validity of musculoskeletal ultrasound (MSU) as a tool to measure cervical IVD height compared to magnetic resonance imaging (MRI) at C4-5, C5-6 and C6-7 spinal segments.

Study design: Exploratory Cross-Sectional Study.

Methods: This three-phase study enrolled 40 participants. Over the course of the study, 900 measurements of IVD were taken. Ten subjects participated in cervical spine MRI and MSU imaging to determine inter-rater reliability for cervical IVD height measurements. Twenty subjects underwent MRI and MSU to obtain images for measurement comparison and Bland-Altman Analysis assessed agreement between MSU and MRI (α=.05) for validity. Randomized, blinded, repeated-measures design using mean values was used to determine inter-rater reliability with intraclass correlation coefficient (ICC(2,3)) and standard error of measurement (SEM) at each IVD segment.

Results: Anterior cervical IVD height of MRI and MSU were ≥0.91(95%CI=0.66-0.98) and ≥0.68(95%CI=0.27-0.92), respectively. Musculoskeletal ultrasound measurement's SEM between raters was comparable to MRI at ≤0.43mm (7.9%). No significant differences nor proportional bias between MRI and MSU measurements (p<0.05) were found at any IVD spinal level, r(18)=0.83, p<0.01. Average underestimation of MSU measurements compared to MRI was ≤ -0.10mm (2.2%).

Conclusion: Methodology used for MSU cervical IVD height imaging and measurements was found to be moderately to highly reliable. Comparisons measurements between MRI and MSU support the use of MSU to measure cervical IVD height in future investigations, including variables which may affect the IVD hydration and homeostasis.

Level of evidence: I 3.

Background: Hip adduction is typically assessed via Ober's test, using a handheld goniometer or inclinometer. As an alternative, a measuring tape, is sometimes used for this purpose in clinical settings, but there is currently no evidence to support this method's reliability. # PurposeThe purpose of this study was to evaluate the intra-rater and inter-rater reliability, along with the measurement precision of assessing hip adduction via Ober's test with a measuring tape.

Study design: Descriptive reliability study.

Methods: A licensed athletic trainer conducted two Ober's tests on each hip of 31 healthy adults (62 hips), 30 minutes apart, and two separate licensed athletic trainers collected measurements of the test using a measuring tape, a handheld goniometer, and a digital inclinometer. Each athletic trainer was blinded to the other's results. An intraclass correlation coefficient was used to assess the inter-rater and intra-rater reliability of each measure.

Results: Measuring tape (R hip: 0.90, L hip: 0.90), handheld goniometer (R hip: 0.80, L hip: 0.83), and digital inclinometer (R hip: 0.86, L hip: 0.90) all demonstrated 'good' inter-rater reliability. Measuring tape (R hip: 0.76, L hip: 0.83), handheld goniometer (R hip: .65, L hip: 0.77), and digital inclinometer (R hip: 0.73, L hip: 0.81) all demonstrated 'moderate' to 'good' intra-rater reliability.

Conclusion: A measuring tape can be used to reliably evaluate hip adduction via Ober's test. Given its relative simplicity and low cost, it may be considered a viable tool for flexibility assessments, where applicable.

Level of evidence: Level 3-Reliability study.

The plantar fascia is composed of fibrous connective tissue that forms a band running from the calcaneal tubercle distally to the toes. One of its main roles is to provide passive support to the medial longitudinal arch on the sole of the foot. This support is compared to a tie-rod tension producer during weight bearing. When loaded excessively during vocational or athletic activities, overuse in the form of plantar fasciitis can occur. Accurate diagnosis fascial injury is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal (MSK) ultrasound offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSK ultrasound has emerged as a valuable, non-invasive imaging modality for evaluating plantar fascia injuries including tissue hypertrophy or structural changes and damage at the calcaneal fascial enthesis. MSK ultrasound is adept at detecting changes in tendon tissue composition and integrity. Furthermore, this manuscript will review the utility of MSK ultrasound in evaluating the plantar fascial injury, including its anatomy, common injury patterns, sonographic techniques, and clinical implications for professional rehabilitation. By integrating MSK ultrasound into clinical practice, providers can improve the accuracy of diagnosis, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to optimal patient outcomes.

Medial patellofemoral ligament (MPFL) reconstruction is a surgical procedure to improve the clinical outcomes for recurrent patellar dislocation. Current literature on MPFL reconstruction lacks the details on rehabilitation protocols and the criteria for clearance to sports participation. Additionally, research on biomechanical deficits after MPFL reconstruction remains limited, and psychological factors influencing return to sport (RTS) are often underemphasized. A comprehensive approach integrating clinical criteria, biomechanical assessments, and psychological considerations may optimize rehabilitation outcomes and RTS success. The purpose of this clinical commentary is to provide a comprehensive review of current literature in MPFL reconstruction rehabilitation and outcomes. This commentary will review published rehabilitation protocols to outline phase-specific guidelines. Current literature related to biomechanical characteristics, patient-reported outcomes, impairment and performance-based outcomes and psychological measures will be summarized. Finally, RTS guidelines with objective criteria will be provided. # Level of Evidence Level 5.