International Journal of Sports Physical Therapy最新文献

Adductor longus injuries represent a significant clinical challenge in sports medicine and rehabilitation, given their impact on athletic performance and risk for recurrence. Diagnostic musculoskeletal ultrasound (MSK-US) provides a dynamic, cost-effective, and radiation-free modality for evaluating adductor pathology, including tendinopathy, partial tears, and complete ruptures. This article reviews the role of MSK-US in the assessment of adductor longus injuries, emphasizing sonographic anatomy, diagnostic accuracy, and clinical utility. Special attention is given to the integration of ultrasound findings into rehabilitation decision-making, including early injury characterization, monitoring tissue healing, and guiding safe return-to-sport progression. For rehabilitation providers, proficiency in the use and interpretation of MSK-US enhances diagnostic precision and supports a more personalized, evidence-informed rehabilitation approach. Clinical Implications: Competency in MSK-US evaluation of the adductor longus enables rehabilitation professionals to contribute meaningfully to early diagnosis, injury grading, and interdisciplinary care decisions.

Medial tibial stress syndrome (MTSS) is a common overuse injury in runners, leading to pain and reduced training capacity. Reliable assessment of biomechanical and clinical outcomes is essential to distinguish true clinical change from measurement error and for guiding rehabilitation and return-to-running decisions. However, evidence for the reliability of commonly used measures in MTSS is limited. # Purpose To determine the test-retest reliability and minimal detectable change (MDC) of common biomechanical and clinical outcomes in runners with MTSS. # Study design Test-retest reliability study. # Methods Twenty-two runners with MTSS were assessed twice, three days apart, by the same examiner. Biomechanical outcomes included center of pressure (COP) trajectory during running and cross-sectional area (CSA) and strength of the flexor hallucis longus (FHL) muscle. Clinical outcomes included linear pain distance on palpation along the posteromedial tibial border, and pain level reported using a visual analog scale (VAS). Paired t-tests were used to analyze the differences between sessions. Intraclass correlation coefficients (ICC_3,k) were calculated to assess reliability. The standard error of measurement (SEM), the MDC and the Bland-Altman plot were calculated. # Results No significant differences between sessions were observed for any outcome. Test-retest reliability was good to excellent for COP (ICC_3,1=0.92), linear pain distance on palpation along the posteromedial tibial border (ICC_3,1=0.94), CSA (ICC_3,3=0.82), and FHL strength (ICC_3,3=0.88). SEM and MDC value were 0.86% and 2.38% for COP, 0.77 cm and 2.12 cm for linear pain distance on palpation along the posteromedial tibial border, 0.23 cm² and 0.63 cm² for CSA, and 0.54 kg and 1.49 kg for FHL strength. The Bland-Altman plot shows the agreement of all variables. # Conclusion Common biomechanical and clinical outcomes in runner with MTSS demonstrated good to excellent test-retest reliability. The established MDC values provide reference thresholds for interpreting meaningful change and support evidence-based rehabilitation and return-to-running protocols. # Level of evidence Level 3.

The rectus abdominis (RA) muscle is a key muscle in the anterior abdominal wall, contributing to motion of trunk flexion, assisting with stabilization of the pelvis, and maintaining intra-abdominal pressure. Its integrity is essential for posture, respiration, and functional movement, and it is frequently implicated in clinical conditions such as abdominal wall hernias, rectus diastasis, muscle strains, and postoperative complications. Accurate evaluation of the RA is therefore critical for both diagnostic and rehabilitative purposes. Musculoskeletal ultrasound (MSKUS) has emerged as a valuable imaging modality for assessing the structure and function of the RA muscle. Offering real-time, dynamic visualization without ionizing radiation, MSKUS enables clinicians and researchers to examine muscle morphology, thickness, echogenicity, and contractile behavior with high precision. Compared with other imaging modalities such as computed tomography or magnetic resonance imaging, MSKUS is more accessible, cost-effective, and well-suited for repeated assessments in both clinical and research settings. Recent advances in MSKUS have expanded its role in evaluating abdominal wall musculature, particularly in populations ranging from athletes and postoperative patients to postpartum women. By providing detailed, noninvasive insights into the RA muscle, MSKUS contributes to improved diagnosis, monitoring of rehabilitation progress, and the development of targeted interventions.

The sport of rodeo is recognized as a high velocity, high intensity activity with a wide range of varying dynamic movements occurring across different rodeo events. High velocities and extreme dynamic range of motion movements, compounded with uncooperative livestock, contribute to elevated risk of injury. While these factors are generally attributed to rodeo injuries, little is known regarding movement limitations of rodeo athletes.

Purpose: Therefore, the purpose of the current investigation was to identify movement pattern differences among athletes from various rodeo events using the Functional Movement Screening (FMS™) test.

Methods: College rodeo athletes from a mid-size university in the southwest region were recruited as participants for this study. Athletes were categorized according to their respected rodeo event: steer wrestling (n = 12), breakaway roping (n = 44), goat tying (n = 17), barrel racing (n = 30), team ropers (n = 23) bronc riding (n = 18), tie down roping (n = 8), or bull riding (n = 10). All rodeo athletes completed an FMS™ test to establish movement efficiency. A General Linear Model was applied to assess event/group FMS™ mean differences to control for heterogeneity of variance across the groups. A repeated Measures ANOVA was utilized to illustrate variance in FMS™ scores within rodeo events.

Results: Study participants consisted of 162 collegiate rodeo athletes, including 71 males (m ± sd; age: 20.5 ± 1.35 years) and 91 females (20.2 ± 1.38 years). There was a significant interaction effect between event and FMS™ tests (F(7, 55) = 8.11, p <.0.01) with robust standard errors applied. The aggregate FMS™ scores did not differ significantly (p = 0.438) between athletes of various rodeo events.

Conclusion: These results suggest event specific movement patterns associated with various rodeo events may affect FMS™ test results for rodeo athletes. Additionally, event specific, preventative exercise prescription can be derived from these findings and may serve as a useful strategy for decreasing potential injury.

Level of evidence: 3.

Background: Injury in populations of runners and triathletes is common. However, while variation in training type and modality is suspected to change the incidence of injury, these factors have not been fully explored.

Purpose: To investigate injury incidence in triathletes and marathon runners to determine which variables are associated with changes in injury reports.

Study design: Retrospective exploratory analysis.

Methods: Athletes who participated in marathons and triathlons were recruited via social media and endurance athletic groups to participate in a survey on injury history, training history, and training modality. Data were analyzed to assess relationships between factors using Chi-square and regression analysis.

Results: Three hundred and eighty-four marathon runners and triathletes participated (mean age 32; 130 males, 253 females, and one undetermined). There was a positive correlation between increased use of cycling as a training modality and overall injuries (t = 3.43, p = 0.00) Increased time spent cross training was positively correlated with overall injuries (t = 2.57, p = 0.01). Volume and frequency of running showed a significant negative correlation with overall injuries (t = -.12, p = 0 .02) as well as a negative correlation between increased weekly swimming time and overall injuries (t = -3.25, p = 0.00).

Conclusion: Although the number of events and type of event participated in had no statistically significant result on injury rate, the number of hours spent cycling and cross training demonstrated a positive relationship to injury, and number of hours spent swimming and running had a negative relationship on injury rate.

Level of evidence: Level 3.

Background: Characterized by intense efforts and rapid changes of direction, futsal performance relies on strength, agility and dynamic balance. Isokinetic testing evaluates neuromuscular strength and asymmetry, providing insights into their relationships with functional strength, aerobic capacity and performance outcomes for elite players.

Objective: This study examined the relationships between lower-limb isokinetic strength and key performance measures, including functional strength (3RM leg extension and leg curl), maximal oxygen uptake, agility and balance, as well as isokinetic asymmetry indices and performance-related asymmetry variables in elite male Vietnamese futsal players.

Study design: Observation cohort study.

Methods: Eighteen elite male futsal players (20.8 ± 3.2 years) were underwent isokinetic strength testing of the hip flexion/extension (45°·s-1), knee (60°·s-1) and ankle plantar /dorsi flexion (60°·s-1), along with 3RM tests for leg extension and leg curl, maximal oxygen uptake (yoyo IR-1 test), agility (arrowhead agility test), and the Y- Balance Test for neuromuscular control/balance. The Pearson product-moment correlation analysis was employed to investigate the correlations among these variables.

Results: Significant positive correlations were found between knee flexor asymmetry index and 3RM leg extension (r = 0.66, p < 0.01) and leg curl (r = 0.59, p < 0.01). A negative association was found between 3RM asymmetry index and hip flexor peak torque in dominant (r = - 0.57, p < 0.05) and non-dominant limbs (r = - 0.52, p < 0.05) and knee extensor peak torque in non-dominant limb (r = 0.50, p < 0.05). Lower limb isokinetic asymmetry index and its associated asymmetry index was foud between the knee flexors and arrowhead agility (r = - 0.53, p < 0.05).

Conclusion: The findings indicate that interlimb strength asymmetries, especially at the knee, correlate with functional strength outcomes in elite male futsal players, potentially guiding future strategies for monitoring and addressing muscular imbalances to enhance performance and potentially reduce injuries.

Level of evidence: 3b.

Rehabilitation following Anterior Cruciate Ligament Reconstruction (ACLR) is a complex process involving the restoration of muscular strength, movement patterns, and functional confidence. Clinical thresholds, defined target values tied to successful outcomes, are frequently used to guide rehabilitation and assess patient progress. While these thresholds may promote rehabilitation advancement and the establishment of structured goals, substantial variability exists in their values and how they are developed. Clinical thresholds are typically established by linking an independent variable (e.g., quadriceps strength) to a dichotomized outcome (e.g., return to running, return to sport, patient-reported function cutoff, etc.). Statistical tools like Receiver Operating Characteristic (ROC) curve analyses are used to determine a single strength value that best predicts a successful outcome, based on the sensitivity and specificity of predicting the outcome. Despite this standardized approach, existing thresholds differ significantly due to variations in outcome definitions, cohort characteristics, and strength testing protocols. This clinical commentary aims to (1) describe the methodology used to establish clinical thresholds, (2) discuss statistical considerations for interpreting these thresholds, and (3) examine the implications of variability in quadriceps strength targets for patient following ACLR.

Level of evidence: 5.

Background: Neuromuscular and kinematic peculiarities in the lower extremities between the sexes could influence the way the posterior kinetic chain interacts during exercises and sprinting, potentially altering hamstring strengthening exercise selection.

Purpose: This study compared sex-differences in four exercises (the rocker, perpetuum mobile fast and slow [PMfast and PMslow] and the Nordic Hamstring exercise) on their potential to simulate sprint-like muscle activity and kinematics.

Methods: Muscle activity of the posterior kinetic chain (biceps femoris [BFlh], semitendinosus [ST], gluteus maximus [GMax] and gastrocnemius medialis [GCM]) was measured with surface electromyography (sEMG) during each exercise and treadmill running at 75% of the individual maximal sprint velocity. sEMG data was normalized to maximal sprinting. 3D-motion capture was employed to assess hip and knee angles.

Results: Eight male and 12 female athletes were included (age: 22.4 years ± 3.1; body mass: 61.0 kg ± 7.1; height: 1.67 m ± 0.07). Peak (MD: 31, p= 0.003, [95%CI: 14-48], SMD: 1.1) and average hamstring activity (MD: 16, p< 0.001, [95%CI: 8-24], SMD: 1.4) was greater in females for every examined task. A sex and muscle interaction showed that females displayed significantly greater peak (MD: 39, p=0.002, [95%CI: 21-60], SMD: 1.3) and mean activity (MD: 20, p< 0.001, [95%CI: 12-29], SMD: 1.5) for ST but not BFlh. Joint angles of peak muscle activity showed significantly greater hip angles during the PMfast in females (MD: 30°, p= 0.014, [95%CI: 15-46°], SMD: 2.1) and an overall significantly smaller knee flexion angle for the ST compared to the BFlh (MD: 7°, p= 0.02, [95%CI: 1-12°], SMD: 0.4). Neither hamstring elongation stress nor muscle selectivity showed significant sex differences.

Discussion: Aside from overall display of greater hamstring, specifically ST activity in all tasks for females, only minor kinematic and no synergist muscle sex-differences were found. Further research exploring sex-specific hamstring neuromuscular strategies is needed.

Level of evidence: 3b.

Background: Limb symmetry index (LSI) of the anterior reach Y-Balance test (YBT) after anterior cruciate ligament (ACL) reconstruction is related to the knee extensor strength LSI. However, a specific cutoff point predicting knee extensor strength LSI at six months postoperatively does not exist. # Purpose To determine a cutoff point for the anterior reach distance LSI at three months postoperatively to identify patients who will not achieve the knee extensor strength LSI ≥90% at six months postoperatively. # Study Design Retrospective cohort study. # Methods Patients who underwent primary ACL reconstruction using hamstring tendon autograft were included for this study. Patients with injured contralateral ACL, knee ligaments other than the ACL or cartilage damage were excluded. Post-ACL reconstruction, athletes were measured for YBT anterior reach distance at three months and isokinetic knee extensor strength at six months; their respective LSIs were calculated. Cutoff points for anterior reach distance LSI at three months postoperatively to identify if knee extensor strength would be achieved at six months postoperatively were determined using a minimum p-value approach, and phi coefficients; sensitivity and specificity were also calculated. # Results Data from 90 patients (53% female, age: 21(12.5) years) who met the inclusion criteria were analyzed. The cutoff point of 90% for the anterior reach distance LSI yielded the lowest p-value and highest chi-square value (p=0.010, chi-square value=6.553). At the cutoff point, a significant association was found between the anterior reach distance LSI at three months and the knee extension strength LSI at six months (φ=0.270), with a sensitivity of 38.1% and a specificity of 88.9%. # Conclusions Patients with an anterior reach distance LSI of <90% at three months postoperatively are at higher risk of not achieving a knee extension muscle LSI of 90% at six months. Anterior reach distance LSI can be safely measured daily during the early postoperative phase; therefore, it may help guide postoperative planning for rehabilitation until return-to-sport discussions begin.

Level of evidence: 3.

While smooth, efficient mechanics and robust therapeutic soft tissue treatment may reduce injury risk in overhead throwing athletes, a simple holistic pre-event treatment approach utilizing nerve flossing techniques may be an effective avenue to combat Ulnar Collateral Ligament (UCL) injury among baseball pitchers. The purpose of this clinical suggestion is to consider the impact of nerve care for elite athletes in the prevention of UCL injury.

Level of evidence: 5.