International Journal of Sports Physical Therapy最新文献

Background: Upper extremity injuries are prevalent among high school baseball players, many of whom continue playing despite mild or early symptoms. Although the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC) is a validated patient-reported outcome (PRO) for overhead athletes, its sensitivity in identifying early dysfunction in field-active adolescent athletes remains unclear.

Hypothesis/purpose: This study aimed to determine the clinical utility of the Japanese version of the KJOC (J-KJOC) for identifying symptomatic high school baseball players and to establish a cutoff score for the early detection of upper extremity dysfunction.

Study design: Cross-sectional study.

Methods: A total of 86 high school male baseball players were categorized into three groups based on their self-reported J-KJOC: asymptomatic, symptomatic but active, and inactive symptomatic. All participants underwent physical assessments, including shoulder range of motion, isometric shoulder strength, grip strength, and pinch strength measurements. Between-group comparisons, receiver operating characteristic (ROC) analysis, and logistic regression were conducted to determine the discriminative performance of the J-KJOC and its association with physical assessments.

Results: The mean age of the participants was 16.3 ± 0.8 years. The J-KJOC scores differed significantly among the three groups (p < 0.01), whereas no significant differences were found in the physical assessments. The ROC analysis revealed a J-KJOC cutoff score of 87.6 with an area under the curve (AUC) of 0.815, yielding 81.5% sensitivity and 72.8% specificity for distinguishing symptomatic players. Logistic regression analysis revealed that only the J-KJOC score, and not conventional physical parameters, was significantly associated with symptoms while playing, across all models.

Conclusion: The J-KJOC demonstrated superior sensitivity to conventional physical assessments in detecting upper extremity dysfunction in high school baseball players. A cutoff score of 87.6 may serve as a valuable screening threshold for early intervention and injury prevention in high school baseball athletes.

Level of evidence: Level 3.

Background: There is a growing body of knowledge linking common gait maladaptations seen in patients who have undergone an anterior cruciate ligament repair (ACLR) procedure and early-onset OA of the knee. These maladaptations present during the early stages of recovery following ACLR and often persist up to five to seven years, and likely beyond, after surgery.

Purpose: The purpose of this scoping review was to investigate the literature on therapeutic interventions after ACLR whose purpose is to normalize gait biomechanics.

Study design: Scoping Review.

Methods: PubMed, SPORTDiscus, CINAHL, Embase, and Scopus databases were searched using predefined terms such as Anterior Cruciate Ligament, Gait, Locomotion. Two authors independently reviewed abstracts and full texts. Inclusion criteria included: 1) articles published between 1990 and 2023, 2) written in English, 3) conducted using human participants, 4) full text available, 5) included participants who were between the ages of 18-35 years and had undergone an ACLR procedure within five years of the relevant intervention, and 6) included outcomes measures focused on walking/gait metrics after receiving a therapeutic intervention. Exclusion criteria were Case studies, case series, and studies using non-living subjects, such as animal studies or human cadaver studies.

Results: Of the 2873 potential studies 14 studies including 404 participants met all criteria. Six studies included targeted strengthening as an adjunct to a normal ACLR rehabilitation protocol, two included partial bodyweight training via treadmill, three included assistive devices for gait or real time feedback via assistive devices, two included vibration therapy, and one included a harmonic oscillator intervention. The high variability of interventions on a limited number of participants makes it difficult to generalize their applicability in the clinical setting on a large scale. Especially as few studies have evaluated the effects of interventions specifically on gait metrics.

Conclusion: There is a noted lack of standardization of prospective interventions to normalize gait after ACLR that also includes a long-term follow-up. These interventions are important to potentially help preserve long-term knee health in individuals with ACLR. There is a present need for rigorous therapeutic intervention that addresses common gait maladaptations after ACLR to potentially help preserve the long-term knee health in individuals with ACLR.

Level of evidence: 2.

Fibrosis of the infrapatellar fat pad (Hoffa's disease) is a frequently missed cause of anterior knee pain in young, active individuals. A diagnostic test that involves injection of the infrapatellar fat pad with local anesthetic and subsequent stress with treadmill running, is a simple in office strategy to effectively diagnose pathology of the fat pad. Selective arthroscopic debridement of the fat pad using superolateral viewing portal aids in adequate visualization not otherwise feasible using standard anterior viewing portals alone. The purpose of this case report is to describe two cases of anterior knee pain arising from fibrosis of the infrapatellar fat pad as identified on imaging and arthroscopy. Both patients were found to suffer from pain arising from a fibrotic infrapatellar fat pad and responded well to surgical intervention.

Level of evidence: 5.

Background: Kinesiophobia is known to lead to a poor rate of return to sports despite following a rigorous rehabilitation protocol following anterior cruciate ligament reconstruction (ACLR).

Purpose: This study aimed to describe the perspectives on rehabilitation and recovery in patients with ACLR categorized as having high or low kinesiophobia in relation to activity, function, and psychological status.

Study design: Mixed methods.

Methods: Participants with primary ACLR (5-12 months postoperative) were recruited and divided into high and low kinesiophobia groups based on the Tampa Scale of Kinesiophobia-11 scores. Participants completed the Tegner activity scale, Marx activity scale, International Knee Documentation Committee, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), the Anterior Cruciate Ligament Return to Sports after Injury scale, and the Generalized Anxiety Disorder-7; and participated in individual semi-structured interviews. Interview data were qualitatively analyzed using the general inductive approach. . Differences in outcomes of the PROs were analyzed using the Mann-Whitney test (p<0.05).

Results: Nine participants with high kinesiophobia (age= 22.2 (3.1) years), five women) and low kinesiophobia groups (n = 6, age=25.5 (3.4) years, four women) were recruited. Participants in both the high and low kinesiophobia groups reported behaviors related to these themes: fear of re-injury, activity avoidance and interlimb asymmetry, and coping mechanisms. Significant differences were found between KOOS quality of life scores between groups (High kinesiophobia group= 56.3 [37.5 -81.3], low kinesiophobia group= 71.9 [62.5-75.0] p= 0.012). No statistical differences were found in any other outcome measures.

Conclusions: Patients with primary ACLR report psychological, biomechanical, and other behavioral changes that may negatively impact recovery. Significantly lower quality of life scores among participants with high kinesiophobia suggest that fear of movement may have a particularly detrimental impact on perceived recovery outcomes. These findings highlight the importance of assessing psychological factors alongside physical recovery measures in patients following ACLR, which may inform more comprehensive rehabilitation approaches.

Level of evidence: Level 3b; Qualitative= NA.

Background: The Single-Leg Heel-Rise test (SLHR) is commonly used to determine the functional status of patients following Achilles tendon rupture (ATR). Several methods exist to quantify performance variables during the SLHR including repetition counting, linear position transducers (LPT) and motion capture/analysis systems; however, they have not been directly compared following operative or non-operative management of ATR. Hypothesis/Purpose: The purpose of this study was to compare three methods to quantify repetition number, heel-rise height, and total work during the SLHR test in patients managed either operatively or non-operatively for ATR.

Study design: Cross-sectional study.

Methods: Twenty-four patients who underwent either operative or nonoperative treatment for complete ATR completed SLHR to failure on a 10° angle board. LPT, two-dimensional motion capture, and the Calf Raise smartphone application recorded heel-rise repetitions and height. Intraclass correlation coefficients and Bland-Altman plots (95% limits of agreement) compared devices. Work was reported as absolute values and limb symmetry index. Two-way analyses of variance were completed for all variables.

Results: In this sample of 17 males and 7 females (operative [n=12; 39.0±8.9 years; 9 male] and non-operative [n=12; 46.2±14.1 years; 8 male] groups) strong, positive correlations were demonstrated between all devices, with the highest occurring between motion capture and the app (r2 =0.997). Bland-Altman Limits of Agreement showed wide limits of agreement across all methods. Peak and accumulated heel-rise height was reduced on the affected limb when measured by all devices, translating to reduced affected limb total work (mean difference: motion capture -403.5 Joules [J] (95%CI -41.5-902.6), app -434.7 J (95%CI -924.3-54.8), and LPT -370.4 J (95%CI -802.6-61.9).

Conclusion: LPT, motion capture, and the calf raise app can be used to quantify repetitions, work, and heel-rise height in patients following ATR. However, device values should not be used interchangeably due to wide limits of agreement across methodologies.

Level of evidence: Level 2c.

Accurately monitoring training intensity is essential in older adults to optimize adaptations and reduce injury risk. While the OMNI-Resistance Exercise Scale for elastic bands (OMNI-RES EB) has been validated post-exercise, applying it from the first repetition (RPE-1) may provide a quick, non-invasive method to individualize training without maximal testing-improving prescription accuracy, limiting fatigue, and supporting autoregulation in vulnerable populations. The purpose of this study was to validate RPE-1 during moderate-velocity elastic resistance training in physically active older adults with prior experience using elastic-band exercise, by analyzing its predictive validity, reliability, and neuromuscular and cardiovascular responses across effort levels. # Study type Quasi-experimental cohort study. # Methods A convenience sample of twelve healthy older adults (≥60 years) with >3 months of experience in elastic band resistance training performed standing military press sets to failure with an elastic band at four target RPE-1 levels (2-8 out of 10). The band color was chosen based on the participant's RPE-1 on the first repetition. Neuromuscular activity of the anterior deltoid and triceps brachii was recorded using surface electromyography, and heart rate, blood pressure, and total repetitions were also measured. Inter-session test-retest reliability of RPE-1 was assessed using intraclass correlation coefficients (ICC). Neuromuscular activity progression was examined across the four RPE-1 levels. Concurrent validity was evaluated through the relationship between RPE-1, total repetitions, and physiological responses. # Results Six women and six men volunteered to participate (66.75±3.49 years; BMI: 24.99±4.32 kg/m2). RPE-1 was strongly associated with neuromuscular activation in both the anterior deltoid (p<0.001, ηp²=0.83) and the long head of the triceps brachii (p=0.001, ηp²=0.52), showing a strong linear increase with perceived effort. RPE-1 also predicted total repetitions (r=-0.71; R2=0.50), independently of participants' strength level, measured by handgrip strength. Reliability was high across variables (ICC=0.84-0.94). Cardiovascular responses did not differ significantly between intensities. Neuromuscular activation increased across set segments, with marginal gains beyond 75% of total volume. # Conclusion RPE-1 via the OMNI-RES EB scale is a valid, and reliable tool for regulating elastic resistance training intensity in older adults, enabling early, efficient, and individualized prescription strategies. # Level of evidence 3b.

The Single Leg Bridge (SLB) is widely prescribed for core and posterior chain strengthening, but normative endurance values are lacking. Establishing benchmarks may enhance rehabilitation, performance screening, and injury risk assessment. # Hypothesis/Purpose The purpose of this study is two-fold: The first is to establish normative values for the SLB endurance test, which physical therapists can use as a reference for rehabilitation. The second is to evaluate whether visually assessing SLB form loss is as accurate as using an app with angle detection in measuring the total duration of SLB during endurance testing. # Study Design Cross-sectional study # Methods Participants were recruited through flyers and word of mouth on the Georgia Southern University campus and within the Savannah community. Participants were excluded if they had medical conditions or recent injuries that could affect single-leg bridge performance. All participants completed a standardized warm-up, followed by a single bilateral trial of the SLB test. Endurance time was recorded using clinician visual estimation and the Angles App, which identified >10° hip deviation from starting position. After excluding outliers, descriptive statistics established normative values, and Pearson correlations assessed agreement between methods. # Results Seventy-seven asymptomatic participants (mean age 20.3 years; 77.7% female, 17.3% male) participated in the study. Adjusted normative values were 65.2 seconds (SD = 32.7) for the dominant leg and 63.9 seconds (SD = 33.7) for the nondominant leg. Strong, statistically significant correlations were observed between clinician visual and app-based measures (dominant leg: r = 0.815, p < 0.001; nondominant leg: r = 0.837, p < 0.001). # Conclusions This study provides the first normative SLB endurance values for healthy young adults. Findings demonstrate that clinician visual estimation strongly aligns with app-based analysis, supporting use of the SLB test in clinical environments where technology access may be limited. The SLB uniquely challenges posterior chain and gluteal endurance under unilateral stabilization and may complement existing core endurance assessments. # Level of Evidence Level 3.

The menisci of the knee are situated between the femur and the tibia. There are two (medial and lateral) wedge-shaped fibrocartilage discs that help to transmit compressive, shear, and rotational loads through the knee. Meniscus injuries are common in sports and activities of daily living that require squatting and pivoting. Acute meniscus injury is more common in sports that involves pivoting and cutting. These acute tears can occur in conjunction with other injuries, such as tears of the anterior cruciate and medial collateral ligaments, whereas older individuals may have a degenerative tear. An older, more seasoned meniscus may be more prone to tears even during what appear to be simple activities, such as getting off the floor or squatting to garden. Accurate diagnosis of meniscus injuries is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative, gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating meniscus injuries, including meniscus tears and their structural properties, composition and continuity. This manuscript will review the utility of MSKUS in evaluating medial and lateral meniscus injuries, including anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. Diagnosis of acute meniscus injury by physical examination is often challenging and is frequently misdiagnosed. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with knee meniscus injuries.

Level of evidence: V.

Background: Scapular dyskinesis (SD) is a common co-morbidity with shoulder complex injuries. However, the presence of shoulder pain (SP) with SD is inconsistent, suggesting a need for individualized assessment and treatment approaches. The purpose of this case report is to describe the differential diagnosis of an athlete with SD and SP and a rehabilitation strategy integrating physical therapy (PT) with a Stroke Efficiency Rating Analysis/Injury Risk Assessment (SER/IRA) to identify biomechanical faults during the tennis serve.

Case description: A 23-year-old male tennis player with right SP was referred to PT by his coach. The subject's SP had been intermittent for nine years, presenting during and after serving and recently intensified, limiting his activities of daily living (ADLs). The subject was diagnosed with secondary shoulder impingement with long head of the bicep and rotator cuff tendinopathy attributed to SD. He completed a 16-week, four-phase rehabilitation program incorporating the SER/IRA and revisions to the biomechanics of his service action, leading to symptom resolution and return to pain-free tennis and ADLs.

Outcomes: The subject's pain level during and after playing tennis decreased from 8/10 to 1/10 following the intervention. The Upper Extremity Functional Score improved by 11 points, while the Disabilities of the Arm, Shoulder, and Hand Questionnaire (disability/symptom and work/sports modules) decreased by 20.87 and 56.25 points, respectively, reflecting clinically meaningful change. The subject returned to tennis and ADLs without pain and remained unrestricted six months after discharge.

Discussion: This case highlights the effectiveness of combining individualized stroke analysis with evidenced based rehabilitation for an individual with SD and SP. The SER/IRA provided insight into the subject's movement quality, guided treatment progression, augmented rehabilitation, and facilitated collaboration between the physical therapist and coach. Such tools may help promote long-term pain reduction, expedite return-to-play, and optimize performance for players with SP and/or SD.

Level of evidence: Level 4.