International Journal of Sports Physical Therapy最新文献

Background: The use of portable hand-held dynamometers is increasing in popularity due to their ease of use in different clinical settings, convenient size, portability, and overall affordability. Reported reliability for external fixation and rater-stabilized hand-held dynamometry (HHD) strength measurements have been found to be 'good' to 'excellent'. Inconsistent agreement has been found between the two stabilization methods and isokinetic HHD testing.

Purpose / hypothesis: Determine the reliability and agreement of HHD measurements in three different rater test positions against three different mechanically produced force magnitudes. The study compared measurements obtained by rater-stabilization to external fixation methods.

Study design: Intra-rater and inter-rater reliability study.

Methods: Ten raters took measurements in three different rater test positions against three different force magnitudes created by an external force. Raters were blinded to the randomized force magnitudes. The rater's measurements were compared to measurements taken against an external fixation stabilization device. To establish reliability, Intraclass Correlation Coefficient (ICC), and Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) were used. To establish agreement, error rates between the rater-stabilized and external fixation stabilization measurements were calculated.

Results: ICC's were found to be 'excellent' at .97 and above. The relative SEM ranged from 0.2% to 0.9 % and the relative MDC ranged from 0.7% to 2.8%. The overall error rate was 15.5% and was influenced by force magnitude.

Conclusion: The use of standardized rater test positions resulted in 'excellent' intra-rater, inter-rater reliability, low SEM, and low MDC for rater-stabilized HHD measurements. A systematic error was observed, with rater-stabilized measurements resulting in higher values compared with values obtained with the external fixation method.

Level of evidence: 3.

Background: Hamstrings and quadriceps strength recovery and restoration of the hamstrings-to-quadriceps ratio (H/Q ratio) is a major concern after anterior cruciate ligament reconstruction (ACLR). Recently, moment-angle profiles and angle-specific H/Q ratios are receiving increasing interest.

Purpose: The first objective of this study was to investigate moment-angle profiles and angle-specific H/Q ratio profiles in athletes with ACLR at the time of RTS. The second objective of this study was to assess whether strength asymmetries identified at the time of RTS, persist after six months.

Study design: Case-Control study.

Methods: Twenty athletes who had undergone ACLR performed isokinetic strength tests for concentric knee flexion and extension (60°/s) at RTS, and three and six months later. Twenty controls were tested once. T-tests were used to compare strength differences between 1) ACLR athletes and controls and 2) the injured and uninjured leg of the ACLR athletes. Finally, to assess strength deficits over time, two-way ANOVAs were used.

Results: Angle-specific analyses and peak moments showed lower hamstrings strength in the injured leg of ACLR athletes compared to their uninjured leg at RTS. Furthermore, angle-specific analyses showed a lower hamstrings strength and H/Q ratio in the injured leg compared to controls at larger knee flexion angles. The latter deficit was not identified with a peak-based analysis. The asymmetries identified at RTS did not change over the six months following RTS.

Conclusions: Athletes with ACLR show strength deficits and asymmetries that persist even six months after RTS. As some asymmetries may go undetected by peak-based analyses, angle-specific analyses are recommended.

Level of evidence: Level 3b.

Observational evaluation of arm elevation is a routine part of the examination of patients with shoulder pain and dysfunction. However, the interdependency of the glenohumeral and scapulothoracic joints during arm elevation presents a challenge for clinicians when attempting to characterize movement impairments and underlying causes. Given that identification of movement impairments related to the scapulothoracic joint (i.e. scapular winging or excessive scapular elevation) are more easily observed compared to movement faults at the glenohumeral joint (i.e. superior or anterior translation of the humeral head) an inherent bias may exist in which clinicians prioritize movement impairments and associated physical impairments at the scapulothoracic joint in developing a treatment plan. Interpreting the cause(s) of abnormal scapulothoracic motion without considering the potential influence of the glenohumeral joint (and vice-versa) may lead to faulty clinical reasoning when developing a plan of care. The purpose of this clinical commentary is to highlight the potential impact of faulty glenohumeral joint mechanics as being contributory to scapulothoracic joint kinematics. We first review the normal kinematics and muscular actions associated with typical arm elevation and then discuss how impairments at the glenohumeral joint may be contributory to faulty scapulothoracic motion. Specifically, we address movement faults characterized by excessive motion of the scapula.

Level of evidence: 5.

Background: An automated pupillometer is a handheld device used to stimulate the pupillary light response (PLR) and track the entirety of the response from constriction to dilation. Pupillometers provide objective data that clinicians can use to identify and assess brain injury. The validity of these devices has been previously established; however, the inter-rater and inter-trial reliability are unknown.

Purpose: The purpose of this study was to assess the inter-rater and inter-trial reliability of the NeurOptics PLR-3000 pupillometer device in measuring pupil size changes, constriction velocities, and dilation velocities. The authors hypothesized that inter-rater and inter-trial reliability would have intraclass correlation coefficients (ICC) greater than or equal to 0.70 for all PLR parameters.

Study: Design: Observational, reliability study Methods: Forty-eight healthy adults (age 18-40 years) without a history of neurological injury, optical surgery, or cognitive impairment participated. Two independent raters used the NeurOptics PLR-3000 to measure PLR parameters in the left and right eyes of each subject. Data for the average and individual trials of each PLR parameter were used to determine inter-rater and inter-trial reliability, respectively. Inter-rater and inter-trial reliability was evaluated using descriptive statistics, ICC, the standard error of measurement, Bland-Altman plots, and the minimal detectable change.

Results: Seven out of eight NeurOptics 3000-PLR parameters demonstrated moderate-to-excellent inter-rater (ICC range 0.72-0.96) and good-to-excellent inter-trial reliability (ICC range 0.76-0.98). The 75% recovery time parameter exhibited moderate inter-rater (ICC range 0.64-0.67) and poor-to-moderate inter-trial (ICC range 0.41-0.65) reliability.

Conclusion: The NeurOptics 3000-PLR demonstrated acceptable reliability in measuring initial and end pupil size, constriction and dilation velocity, and latency to change between different users and trials. However, the device exhibited unacceptable reliability when measuring the time to 75% pupil size recovery. The device can be used in detecting and monitoring brain injury but should be limited to reliable measures only.

Injuries to the ulnar collateral ligament (UCL), have become increasingly prevalent among overhead-throwing athletes, especially baseball pitchers. From 2011 to 2023, UCL injuries were the most common injury in Major League Baseball (MLB). Contributing factors include high pitching velocity, fatigue, overuse, and year-round pitching. Research indicates that 25% of MLB pitchers and 14% of Minor League pitchers have undergone UCL surgery, with these numbers steadily rising. After traditional UCL reconstruction, 83% of athletes return to the same or higher levels of play. While the success rate for UCL surgery is high, revision surgeries are becoming more frequent, with mixed outcomes. This underscores the need for improved surgical techniques and rehabilitation strategies. The hybrid UCL reconstruction technique presents a reliable and effective solution for treating UCL injuries, combining the benefits of autogenous grafting with internal brace augmentation. Current research, however, lacks focus on the surgical technique and rehabilitation following UCL hybrid surgery. Achieving successful outcomes with this procedure relies on a collaborative approach, from surgery to rehabilitation with adherence to the rehabilitation protocol and throwing program. Full recovery typically requires 12-14 months, depending on the athlete's level of play. With over 400 successful surgeries to date, this technique has proven to enhance stability and facilitate recovery, particularly in elite-level throwing athletes. The purpose of this paper is to describe this new surgical technique and its associated rehabilitation programs, emphasizing the importance of rehabilitation under the guidance of a rehabilitation professional experienced with overhead athletes. Level of Evidence: 5.

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: Cryotherapy, long used for its pain-relieving and anti-inflammatory effects, is widely applied in sports medicine, physiotherapy, and postoperative care. Advances in cryotherapy methods, including the use of topical vapocoolant sprays, offer enhanced pain management and support recovery from musculoskeletal injuries by alleviating pain and reducing swelling in a targeted manner.

Hypothesis/purpose: The primary aim was to assess both immediate and sustained pain relief in subjects with mild to moderate musculoskeletal complaints.

Study design: Observational cohort study.

Methods: Fifty-nine participants with mild to moderate musculoskeletal pain participated in a three-week observational study evaluating a cryotherapy spray. Pain and range of motion (ROM) were assessed using the Visual Analogue Scale (VAS) and goniometer measurements at multiple time points, including T-1 (before treatment), T0 (beginning of treatment), T2-min, T5-min, T10-min, T15-min, T30-min, T60-min, T7-days, T14-days, while participants were actively receiving treatment exclusively with the cryotherapy spray, and T21-days (1 week after treatment cessation). Acceptability Test and additional subjective questionnaires evaluated participants analysis of cooling sensation and product tolerance. Data were analyzed using Cumulative Logit Mixed Models (CLMM) and the non-parametric Friedman test for repeated measures.

Results: The cryotherapy spray significantly reduced pain (VAS) from baseline (p < 0.001, Hedges' g = -1.90) and improved joint mobility (ROM) with derived scores increasing from 3 (3-4) to 4 (4-4) by Day 21 (p < 0.001). Rapid pain relief was reported by 35% of participants within 10 seconds, with 80% experiencing relief within three minutes. Comfort ratings were consistently high, with 95% of participants expressing satisfaction at Day 0, rising to 99% by Day 14. Global efficacy satisfaction measured by a subjective Likert scale also increased from 75% at baseline to 95% by Day 14. No adverse events were reported.

Conclusion: This study supports the effectiveness of the cryotherapy spray in reducing pain and improving joint mobility, with both immediate and sustained benefits. High patient satisfaction and a favorable safety profile suggest its potential for clinical use. Further controlled studies could confirm its efficacy in broader populations.

Level of evidence: Level 3.

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.