International Journal of Sports Physical Therapy最新文献

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.

Background: Medial tibial stress syndrome (MTSS) is a common overuse injury characterized by activity-induced pain along the distal medial tibial border. Current best practice includes rest and progressive resistance training. However, some patients with MTSS may be unable to tolerate the loading during exercise. Blood-flow restriction training using low loads (LL-BFR) may induce similar physiological and structural adaptations as heavy resistance training but without peak loads. This could potentially allow the athlete to continue sports activities during rehabilitation.

Purpose: The purpose of this case series was to describe an exercise program utilizing LL-BFR training for athletes with running-related MTSS.

Study design: Case series.

Methods: Six recreational athletes (one handball player, one soccer player, and four runners) with MTSS were recruited. Inclusion criteria included pain along the distal two-thirds medial tibial border occurring during or after activity. Exclusion criteria were symptoms of compartment syndrome, tibial stress fracture, or contraindications for BFR training. Participants underwent a progressive six-week home-based LL-BFR training intervention with three sessions per week and were allowed to continue sports activities if pain was ≤ NRS 5. Outcome measures included change in standardized running performance (distance and pain level), pain pressure threshold (algometry), and self-reported physical function.

Results: Five athletes experienced improvements in running performance (pain and/or distance) and self-reported function. One athlete sustained an injury unrelated to the LL-BFR training, and therefore the running post-test could not be completed. Adherence to exercise was high, and post-test interviews revealed positive feedback on the training method, with no side effects reported.

Conclusion: This case series demonstrated that following a therapeutic exercise program utilizing LL-BFR training improvements in pain and function were seen in athletes with MTSS. BFR may allow clinicians to prescribe lower-load exercises, facilitating continued sports participation. Future research should compare the effectiveness of exercise programs for MTSS with and without LL-BFR training.

Level of evidence: Level V.

Background: Due to its significant unilateral predominance, tennis can provoke functional and morphological asymmetries that develop over time and may result in undesired morphological alterations.

Hypothesis/purpose: The goals of this study were a) to assess glenohumeral range of motion and muscular stiffness in young tennis players with and without a history of shoulder pain and b) to examine interlimb asymmetries in these variables in both groups. It was hypothesized that players with a history of shoulder pain would show a reduced glenohumeral internal rotation (IR) and total arc of motion (TAM) and increased stiffness in internal rotator muscles compared to those without shoulder pain.

Study design: Cross-sectional observational study.

Methods: Twenty-five participants participated in the study (11 with a history of shoulder pain and 14 without pain). Participants performed stiffness measurements on muscles involved in the main tennis stroke motions alongside range of motion examinations on the dominant (D) and non-dominant (ND) extremities including IR, external shoulder rotation (ER), and TAM. A two-way mixed-design ANOVA analyzed group and limb effects, with effect sizes classified as small, medium, or large. Significant effects were further examined using Bonferroni post hoc tests.

Results: There were significant differences between the shoulder pain and no shoulder pain group in the D IR (-3.1º, 6.43%, p = 0.048; effect size [ES] = 0.58) and D TAM (-6.1º, 3.01%, p = 0.024; ES = 0.66). Moreover, significant differences were found between the D and ND extremities in IR in both groups (-9.2º, 14.94%, p < 0.001; ES = -1.72) and TAM in the shoulder pain group (-5.6º, 2,77%, p = 0.038; ES = 0.61). Stiffness measurements showed no significant differences between groups or extremities.

Conclusions: Significantly lower values of D IR and TAM and higher IR asymmetries in the shoulder pain group suggest that a deficit in these parameters could be associated with shoulder pain history in junior competitors.

Level of evidence: 2.

Background and purpose: Many screening tools are used to identify eating disorders (ED) and disordered eating (DE) in individuals. The purpose of this scoping review was to identify the most commonly used ED/DE screening tools for young male and female athletes.

Study design: Scoping Review.

Methods: Following the Johanna Briggs Institute scoping review guidelines, PubMed, CINAHL Complete, PsycInfo, SPORTdiscus, and Web of Science Core Collection databases were searched using keywords related to eating disorder, disordered eating, athletes, and screening. Included articles were randomized controlled trials, cohort studies, or cross-sectional studies published in English between 2011-2023; included primarily non-aesthetic athletes aged 14-24 years; and utilized an ED/DE screening tool for diagnostic purposes. Articles were excluded if analysis of ED/DE was a secondary purpose or < 20 athletes participated. Tools utilized and demographic and outcomes data were extracted and qualitatively analyzed.

Results: Thirty articles were included. The Eating Attitudes Test-26 (EAT-26), the Sick, Control, One, Fat, Food (SCOFF) questionnaire, and the Eating Disorder Inventory (EDI) were most used among all included articles. Three articles examined only males and used a variety of tools. Five articles utilized a tool specifically designed for athletes: the Eating Disorder Screen for Athletes (EDSA), Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) or the ATHLETE questionnaire.

Discussion: While the EAT-26 is most used for diagnosing ED/DE risk within young athletes, clinical utility of screening tools for male athletes is varied. Combinations of tools utilized for examining ED/DE risk in athletes are not agreed upon. Continued research is needed to assess the clinical utility of screening tools that identify ED/DE risk specifically in athletes. Tool adjustment or development for male athletes may be necessary.

Level of evidence: 2a.

Chronic lateral ankle instability is a common diagnosis in foot and ankle clinics. Internal Brace (IB) augmentation is a surgical procedure that utilizes fibertape augmentation of the lateral ankle ligaments. Studies have shown the superiority of fibertape augmentation over traditional lateral ankle stabilization procedures such as the Brostrom or Brostrom-Gould. The IB procedure has been described elsewhere and the fixation involves placing bone anchors with attached suture tape at each end of the Brostrom repair augmenting the fixation. Various studies exist that support the mechanical advantage of the Brostrom with IB over non augmented repair. This technique allows for earlier weight bearing and range of motion which translates into earlier return to activity and sport. While there are guidelines for rehabilitation after Brostrom procedures, there are currently no guidelines regarding rehabilitation after the IB. The purpose of this clinical commentary is to describe an early mobility and rehabilitation protocol after IB augmentation for the ankle. The post operative protocol provides treatment goals, weight bearing status recommendations, and rehabilitation intervention suggestions after IB augmentation.

Level of clinical evidence: V.