International Journal of Sports Physical Therapy最新文献

Background and purpose: Clinical practice guidelines (CPGs) are systematically developed statements designed to promote evidence-based practice, assist in decision-making, and reduce unwarranted deviations in practice. The purpose of this study was to describe the awareness and attitudes of physical therapists (PTs) towards using the Hamstring Strain Injury in Athletes (HSIA) CPG and determine the relationship between barriers, utility, and knowledge of practice guidelines with the behavioral characteristics and clinical care patterns of PTs.

Study design: Explorative survey.

Methods: Members of the American Academy of Sports Physical Therapy (AASPT) were surveyed regarding their perceived value and application of the HSIA CPG. Descriptive measures of central tendencies and nonparametric analysis were used to describe the data and identify differences. A forward stepwise regression was used to identify variables to explain if the level of CPG awareness and frequency of use were related to selected attitudes, beliefs, and barriers to utilization of the CPG.

Results: Eighty-seven percent of respondents were aware of the CPG resource. Fifty-six percent had read, reviewed, and/or integrated the recommendations into clinical practice. The respondents had a substantial positive opinion regarding its necessity, assistance in decision-making, ease of implementation, ability to improve outcomes, and reduction of unwarranted practice variation. Only 15% of respondents believed the CPG did not provide adequate evidence to adopt its recommendations. Barriers to utilization were the CPG's ability to account for provider expertise and its shortcomings in universally applying its findings to all patients' needs and expectations. Given a specific hamstring injury vignette, respondents accurately chose evidence-based examination, intervention, and injury prevention strategies in the vast majority of cases.

Conclusion: The HSIA CPG is a valuable resource for PTs in managing athletic injuries. The guideline clearly describes the aims, objectives, population, and evidence that contributes to each recommendation and is being used to improve rehabilitative care.

Level of evidence: 3b.

Background: Knee strength is a critical measure of successful rehabilitation following medial patellofemoral ligament reconstruction (MPFLR). Yet, strength outcomes of youth following MPFLR are not widely reported.

Hypothesis/purpose: The primary purpose was to profile isokinetic strength outcomes by sex and age among youth following MPFLR. A secondary purpose was to determine the relationship between normalized isokinetic strength values and patient-reported outcome scores by age and sex. The hypotheses were that 1) males would demonstrate higher normalized strength, and that 2) a higher proportion of males would achieve ≥90% limb symmetry when compared to females.

Study design: Cross-sectional.

Methods: At 6.9±2.1 months after MPFLR, 162 patients completed isokinetic assessment of knee extension (KE) and flexion (KF) strength at 180°/s and 300°/s on both limbs (uninvolved [UN], involved [INV]). Strength data and patient-reported outcome scores, including the International Knee Documentation Committee (IKDC) Subjective Knee Form and Pediatric Quality of Life Inventory (PedsQL) were extracted from electronic medical records. Descriptive statistics were used to categorize data by age (Pre-adolescent, Early Adolescent, Late Adolescent, Young Adult) and sex. Independent-samples t-tests and chi-square analyses were used to determine sex-based differences in strength. Multiple linear regression analyses were used to determine the relationship between strength and patient-reported function.

Results: Among Early Adolescents, males demonstrated higher normalized KE strength at 300°/s compared to females (UN: 1.27±0.3 vs. 1.07±0.3 [p=0.01]; INV: 1.07±0.2 vs. 0.92±0.3 [p=0.03]). Among Late Adolescents, males demonstrated higher INV limb strength for KE 180°/s (1.55±0.53 vs. 1.24±0.5; p=0.02), KE 300°/s (1.25±0.4 vs. 1.00±0.4; p=0.01), and KF 180°/s (0.98±0.4 vs. 0.82±0.3; p=0.05). A higher proportion of Late Adolescent and Young Adult males achieved ≥90% LSI compared to females (p=<0.01-0.04). Regression models estimating IKDC and PedsQL scores were significant with INV KE strength as an independent variable (p=0.01-0.03).

Conclusions: Males demonstrated higher normalized strength and symmetry compared to females following MPFLR. Higher INV KE strength was associated with higher patient-reported function.

Level of evidence: 2b.

Background: Current rehabilitation practices following anterior cruciate ligament reconstruction (ACLr) do not guarantee recovery of gait mechanics suggesting that gait specific interventions are needed. Increasing gait speed implicitly increases lower extremity demands; however, it is not known if increased treadmill speed will result in improved knee mechanics in early recovery post-ACLr. Therefore, the purpose of this study was to determine how individuals four months post-ACLr respond to the demands of increased speed during treadmill gait.

Study design: Cross-sectional.

Methods: Ten individuals 109.2±19.9 days post-ACLr and twelve uninjured individuals participated. Participants walked on a treadmill at self-selected (SS), 25% faster (SS25) and 50% faster (SS50) speeds. Kinematic and kinetic data were used to calculate net joint moments using standard inverse dynamic equations. Knee power was calculated as the scalar product of angular velocity and sagittal plane net joint moment. Knee flexion excursion was calculated from initial contact to the subsequent knee flexion peak. A 3 X 2 ANOVA assessed the effect of group and speed (SS, SS25, SS50) on surgical (or control) knee extensor moment, power absorption, knee excursion, GRFs and between limb symmetry.

Results: For controls, knee extensor moment, power absorption, excursion, and GRFs increased at each speed. For ACLr, knee loading variables increased between SS to SS25 without changes in limb symmetry. No further increase in knee moments were observed between SS25 and SS50, but limb symmetry decreased in extensor moment, power, and GRFs.

Conclusion: At four months post-ACLr, a moderate increase in treadmill speed may provide a stimulus to improve knee loading without increased asymmetries. Larger increases in speed should be exercised with caution to avoid undesirable between limb compensations. A progressive increase in demand to improve knee loading deficits during early recovery of ACLr is warranted.

Level of evidence: 2.

Background: Sports chiropractors are increasingly being consulted in the assessment, treatment and rehabilitation of athletes. The purpose of this case series was to describe a multimodal chiropractic treatment approach to address medial elbow injuries in amateur/elite javelin throwers.

Case descriptions: Five javelin throwers (3 Males & 2 Females) aged 15-24 years presented to two chiropractic clinics with signs/symptoms including pain, instability, postural dysfunction, and dysfunctional range of motion of the glenohumeral and elbow joints. Diagnoses included tear/rupture of the ulnar collateral ligament, medial epicondylitis, valgus extension overload syndrome (posteromedial impingement), reactive bone formation of the olecranon fossa, avulsion fracture of the medial epicondyle/sublime tubercle, distal triceps tendinopathy, scapular dyskinesis, glenohumeral internal rotation deficit, anterior glenohumeral capsulitis, instability of the glenohumeral joint, rotator cuff pathology, and subacromial impingement.

Interventions and outcomes: A multimodal treatment approach was utilized for all five athletes which included; soft tissue therapy (active release techniques [ART]), ischemic pressure, cross-friction massage, dry needling, low level laser therapy (LLLT)/Photobiomodulation (PBM), spinal and peripheral joint manipulation/mobilization and a rehabilitation program that included proprioceptive and postural retraining, strength and Javelin specific technical retraining. Numeric rating scale (NRS), Conway scale, activities of daily living (ADL's) and sport specific functions were used to assess change. All javelin throwers returned to above pre-injury performance 12-26 weeks post injury presentation. At six and 12 month follow up all patients continued to be symptom free, performing normal ADL's and sport specific functions.

Conclusions: This case series presents results which demonstrate positive outcomes after using a multimodal chiropractic treatment and management approach in five javelin throwers with medial elbow injuries.

Level of evidence: 5 (case series).

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.