International Journal of Sports Physical Therapy最新文献

Background: Upper extremity injuries are common in baseball spanning from youth through professional leagues, especially in preseason. Although there are some arbitrary guidelines for number of throws during practices and games, there is no current information on workload during preseason in baseball pitchers.

Hypothesis/purpose: The purpose of this study was to quantify the number of throws and workload, as defined by angular velocity, during preseason training in a collegiate baseball season.

Study design: Descriptive Epidemiology Study.

Methods: Nine baseball pitchers wore an inertial measurement unit on the forearm during all preseason training. Movements were captured at 100Hz and classified as a throw when the forearm velocity was greater than 800°/second. Peak angular velocity was exported for each throw and total workload was calculated as the median angular velocity multiplied by total throws for each day. Chronic workload was calculated as the rolling 28 days average workload and acute workload was calculated as the average seven-day workload. Acute to chronic workload ratio (ACWR) was calculated for each week. A repeated measures ANOVA with pairwise comparisons was used to compare throws, acute workload, and ACWR between weeks. Cohen's d effect sizes were calculated for all significant differences.

Results: The pitchers averaged 1990.6 ± 881.7 throws throughout preseason at an average angular velocity of 1686.2 ± 334.9 m/s. Acute workload was reduced in Week 4 compared to Week 2 (p=0.018, d=1.73) and week 3 (p=0.007, d =2.30). ACWR was above 1.27 on weeks 1,2,3, and 5. ACWR was significantly reduced in week 4 (0.79) compared to week 3 (1.50; p=0.021, d =0.71).

Conclusion: ACWR was above 1.27 for four of the six weeks of preseason, suggesting that there may be a need to reduce workload and progressively build during the preseason. Clinicians should consider monitoring workload during preseason throwing to decrease risk of chronic overuse injuries.

Level of evidence: 2c.

Background/purpose: The assessment of ankle plantarflexion force is commonly required in athletic performance and clinical rehabilitation settings to assess the integrity of the calf and lower limb musculature. The force generating capacity of the soleus muscle is thought to be important in many aspects of sporting and everyday function. Unfortunately, there are only a few reliable tests describing the assessment of the strength of the soleus muscle, especially in dorsiflexion greater than plantar grade/neutral which mimics ankle joint positions associated with higher ground contact forces. Accordingly, the purpose of this study is to describe the reliability, feasibility, and clinimetrics of a novel test of plantarflexion force in a clinical setting.

Methods: Test-retest reliability of a seated isometric plantar flexion strength test performed a minimum of one day apart (maximum of six) using the maximum value of four trials was investigated using a force plate and custom apparatus in 61 volunteer adults (of varying activity levels (Tegner one to ten). Inter-rater reliability (ICC_2,1), Bland-Altman, and minimal detectable change values were estimated.

Results: Sixty-one subjects were tested (49 male, 12 female, 39.6±12.6 years, 81.1±13.8kg). Excellent test-retest reliability was demonstrated (ICC_2,1)=0.976 [0.97 to 0.98], p<0.001; and minimal detectable change (MDC) was found to be 118N.

Conclusion: Excellent test-retest reliability and a minimal detectable change of 118N (14.8% bodyweight) were demonstrated for this measure of plantar flexion force. MDC data can inform clinical progression and between-limb differences in healthy and injured individuals. Further, these results can be used to explore the clinical importance of the measurement using the instrumentation.

Level of evidence: 3b.

Musculoskeletal ultrasound (MSKUS) is a pivotal imaging modality for the evaluation and management of Achilles tendon pathologies. Its ability to provide real-time, high-resolution imaging facilitates accurate diagnosis, dynamic assessment, and precise therapeutic interventions. The Achilles tendon, the largest and strongest tendon in the body, is critical for lower limb function and prone to a variety of pathologies, particularly in athletes and active individuals. This paper explores the normal sonographic anatomy of the Achilles tendon, common pathological findings-including tendinopathy, tears, insertional disorders, and retrocalcaneal bursitis-and ultrasound techniques to optimize diagnostic accuracy. The integration of MSKUS into clinical practice has revolutionized the assessment and treatment of Achilles tendon injuries, offering a cost-effective, radiation-free alternative to other imaging modalities such as magnetic resonance imaging (MRI).

Background: Dynamic knee valgus (DKV) is widely considered a risk factor for injuries, despite contradictory research. Consequently, athletic performance and injury rehabilitation cueing has primarily focused on keeping the "knees out".

Purpose: The purpose of this study was to assess jump performance measures and anatomical contributions.

Study design: Cross-Sectional Study.

Methods: Jump height, ground contact time, reactive strength index, and DKV was collected with the MyJump2 and Coach My Video apps. Static anatomical measurements were collected. Subjects completed nine jumps with each leg using the same set-up; performing three single leg six-inch depth jumps with their natural form, three depth jumps with external cuing towards increased DKV, and three depth jumps with cuing towards no DKV. ANOVA was used to compare jump data. Pearson Correlation Coefficients were used to assess relationships between DKV and anatomical measurements, jump height, ground contact time, and reactive strength index. Intraclass correlation coefficient (ICC) was used to assess inter-rater reliability of MyJump2 and Coach My Video measurements.

Results: 50 subjects (35 included) participated in this study. With a cued DKV jump, ground contact time had a moderate positive correlation with DKV measurements (r=.49, p<0.01), however, this was not the case with subjects' natural jump and cued no DKV alignment jumps. Static anatomical measurements of static knee valgus and Q-angle had a weak positive correlation with DKV measurements for subjects' natural jumps (r=.37, p<0.01 and r=.34, p=0.04, respectively). When DKV measurements were normalized to an anatomical measurement, no correlations existed with any of the performance measurements. There was very strong inter-rater reliability (ICC=.96-.99) of all the measurements.

Conclusion: Bony anatomical alignment should be considered alongside kinematics, as normalization controlled for the differences in DKV. Future research should normalize DKV measurements by bony anatomy when addressing DKV and jump performance.

Level of evidence: 2c.

Background: The United States military strives to prepare soldiers physically and mentally for war while preventing injury and attrition. Previous research has focused on physical injury risk factors but has not prospectively examined psychological risk factors.

Purpose: This study's purpose was to investigate whether self-efficacy is a risk factor for musculoskeletal injury in an initial military training environment and compare it to other known risk factors.

Study design: Prospective, Longitudinal Cohort Study.

Materials and methods: Shortly after starting cadet basic training, new cadets rated self-efficacy by an 11-point questionnaire. Other risk factor data including injury history, sex, height, weight, body mass index, age, aerobic fitness, upper body muscular endurance, core muscular endurance and previous military experience were collected by self-report questionnaire and military fitness testing. The primary dependent variable was musculoskeletal injury that originated during the seven-week course. Independent variables were compared between participants who were and were not injured using Chi-squared test, t-tests, Cox regression analysis and time to injury was evaluated using Kaplan-Meyer survival analyses.

Results: Seven hundred eighty-one (65.1%) new cadets were eligible and consented to participate. Injured cadets had significantly lower self-efficacy scores (p=0.003 and p=<0.001), shorter height (p=<0.001), lower weight (p=0.036), lower push-up and plank performance (p=<0.001), slower two-mile run performance (p=<0.001), and females sustained a proportionally higher number of injuries than males (p=<0.001). Cadets with low self-efficacy, shorter height, lower hand release push-up performance, lower plank performance and slower two-mile run performance were at greater risk for musculoskeletal injury. Cadets with less self-efficacy were also less likely to continue uninjured throughout cadet basic training according to a Kaplan-Meier survival analysis (log rank test<0.002). Multivariable Cox regression revealed that only aerobic fitness predicted musculoskeletal injury (HR=1.005 [1.003-1.006], p=<0.001).

Conclusions: Participants with less self-efficacy sustained injuries earlier and more often than those with greater self-efficacy. However, aerobic fitness alone predicted future injury after controlling for all risk factors. Resolved prior injury was not a risk factor for future injury.

Level of evidence 2b: Individual cohort study.

Introduction: Anterior cruciate ligament (ACL) reconstruction involves prolonged rehabilitation, with Return to Sport (RTS) as a key goal for athletes. Integrating Dual Task (DT) strategies, which combine cognitive and physical tasks, is critical, as multitasking mirrors real-world and sports-specific demands. Assessing how distractions affect performance is essential to optimize RTS outcomes for both the reconstructed and healthy limbs.

Purpose: To analyze the influence of DT on the performance of the Triple Hop Test for distance (THD) in individuals' status post ACL reconstruction.

Study type: Cross Sectional.

Materials and methods: Seventeen patients post-ACL were recruited and performed THD under two conditions: single task (standard condition) and dual task (with an added neurocognitive task). Assessments were conducted on both the healthy and the previously injured limb over six meters, measured via a standard measuring tape. Paired t-tests and Mann-Whitney-Wilcoxon or Kruskal-Wallis tests were applied to investigate differences. Categorical variables were compared using chi-squared tests.

Results: There was a significant difference in average distance between single task performances in the healthy and previously operated limbs, with a difference of 20.71 cm (p=0.016). A significant difference was also observed in DT performance, with a distance variation of 10.41 cm (p=0.038). Comparing performances, both the healthy and the ACL-reconstructed limbs showed performance deterioration under DT conditions, with a greater percentage decline in the healthy limb.

Conclusions: Dual Task conditions appear to hinder performance in the THD in both the healthy and post-ACL reconstructed limbs.

Level of evidence: 3b.

Background: Submaximal isometric exercises are used for pain control and neuromuscular facilitation. Typically, an ipsilateral maximal voluntary isometric contraction (MVIC) is used as a reference; however, when this is not clinically feasible, an alternative must be considered. Two options are (1) the no reference (NR) method (submaximal contraction at a self-perceived effort level without reference) and (2) the reciprocal reference (RR) method (MVIC on the contralateral side serves as a reference for a submaximal effort-level on the ipsilateral side). No research evidence exists as to which alternative method is more accurate at the shoulder.

Purpose: To determine the accuracy of the NR and RR methods in estimating target muscle force during shoulder ER and IR submaximal isometric contractions among healthy adults.

Study design: Observational cross-sectional.

Methods: Isometric shoulder force was measured via a hand-held dynamometer on 48 healthy participants (36 females and 12 males) mean age of 27.4 ±1.6 years. Both methods (NR and RR), direction of force (IR and ER), and starting test-side (right or left) were randomized. RR testing involved a contralateral MVIC (reference) prior to a 50% submaximal contraction. NR testing entailed a 50% submaximal contraction with no prior reference MVIC.

Results: Actual submaximal efforts were compared to MVIC-based estimated submaximal efforts. Significant moderate - good correlations existed for both the RR (r = 0.691) and NR (r = 0.620) methods, regardless of test-side or shoulder motion. Significant moderate - good correlations were found between both methods for both ER [RR (r = 0.717) and NR (r = 0.614)] and IR [RR (r = 0.669) and NR (r = 0.628)].

Conclusion: Both methods had moderate - good accuracy levels and were not influenced by the test side or direction of force. Either method (RR or NR) can be equally useful for shoulder isometric exercise prescription when an ipsilateral reference cannot be determined.

Level of evidence: 3.

Background and purpose: Anterior cruciate ligament (ACL) tears often occur due to non-contact mechanisms in landing within females. Impact loading and aberrant landings may be addressed with augmented feedback training. The purpose of this study was to identify which female athletes most readily respond to a single session of augmented feedback to attenuate vGRF, by considering baseline peak vGFR and change in vGRF during training.

Design: Repeated Measures.

Methods: One hundred, forty-seven female athletes landed from 50 cm onto two force platforms with and without augmented feedback of vertical ground reaction force (vGRF), vGRF symmetry, and lower extremity position. Each performed six baseline trials and two sets of six training trials with cues. Following training, athletes completed six post-feedback trials (with no feedback) and six dual-task (transfer) trials where they randomly caught a basketball during landing. Peak vGRF was measured. Mean responses were reported for the sets of six trials. Participants were grouped based on their responses to training. Linear regression was used to indicate how well initial performance and response predicted the final response.

Results: Four groups were identified, with 107 participants showing high baseline ground reaction forces and response to training. Only 23 participants (16.4%) did not respond to training. Baseline vGRF predicted post-feedback vGRF and transfer task vGRF (R2=0.508 and R2=0.400) across all participants. When change in vGRF was assessed following two blocks of augmented feedback training, prediction of responders improved with post-feedback vGRF and transfer vGRF (R2=0.911 and R2=0.761).

Conclusions: The combination of both baseline ground reaction force and response to initial training is more accurate than baseline measures alone in identifying those who respond to training. Assessing initial response to training may be necessary to more accurately identify individuals most likely to benefit from augmented feedback training and who may require further evaluation and training.

Level of evidence: 2b.

Musculoskeletal ultrasound (MSKUS) has emerged as a valuable diagnostic tool in the evaluation and management of lateral elbow pathologies. This imaging modality provides high-resolution, dynamic visualization of superficial soft tissue structures, making it particularly advantageous for assessing conditions such as lateral epicondylitis (tennis elbow), ligamentous injuries, radial tunnel syndrome, and other common disorders. This article reviews the utility of MSKUS for rehabilitation providers, focusing on its role in accurately identifying pathoanatomical changes, guiding treatment strategies, and monitoring therapeutic outcomes. Specific emphasis is placed on the integration of diagnostic ultrasound in clinical practice, imaging techniques, and its advantages compared to other modalities. By enhancing diagnostic accuracy and facilitating targeted interventions, MSKUS serves as a critical adjunct in the comprehensive care of lateral elbow conditions.

Background: The sport of rifle places unique physical demands on its athletes relative to other collegiate sports, including maintaining lumbar-straining positions for extended time. Anecdotal reports of low back pain (LBP) are common among collegiate rifle athletes, but the prevalence of LBP in this population has not yet been established in the literature.

Purpose: The purpose of this study was to survey collegiate rifle athletes to quantify the prevalence and impact of low back pain in this population and identify possible contributing factors including the COVID-19 pandemic. It was hypothesized that over 50% of athletes would report an episode of LBP due to participation in collegiate rifle events.

Study design: Cross-Sectional Study.

Methods: Athletes at least 18 years of age who were members of a collegiate rifle program during the 2019-2020 season were surveyed via an online questionnaire. The questionnaire included four sections: (a) demographics, (b) presence of LBP, (c) the impact of pain episodes on daily activities, and (d) shooting stance and training characteristics.

Results: Responses from 114 athletes were collected. A total of 101 (89%) respondents indicated having experienced at least one episode of LBP. Of those, 24% also missed at least one day of training or competition during the 2019-2020 season because of LBP. During the COVID-19 pandemic, 60% were unable to receive the same level of medical care while 69% experienced equal or greater pain levels. An association between sex and LBP was statistically significant (p<0.001).

Conclusion: There is a high prevalence of LBP in collegiate rifle athletes. It is necessary for Athletic Training staff and other medical professionals to be aware of this for prevention and treatment, as it has significant impacts including missed playing time. More research on predisposing factors such as sex and training duration or positional characteristics would benefit management of this injury.

Level of evidence: 3.