International Journal of Sports Physical Therapy最新文献

Background: The Western Australian Football League (WAFL) introduced a new umpire driven 'blue-card rule' for concussion, but its benefit to the sports medicine team is unknown.

Purpose: To determine the experiences and perceptions of medical staff within the 2022-2023 Men's and Women's WAFL competitions following the introduction of the 'blue-card rule'.

Study design: Cross-sectional study.

Method: An online survey was delivered through Qualtrics to all WAFL medical staff (doctors, physiotherapists, head trainers). The survey contained four sections (demographics, concussion knowledge, concussion exposure and blue-card perceptions) with closed and multiple-answer questions. Standard methods for reporting descriptive data were applied, including mean ± standard deviation (SD) and proportions (%). Between-group differences were assessed using chi-square tests, and significance was accepted at p <0.05.

Results: Response rate was 48% (n=7 doctors, n=12 physiotherapists, n=12 head trainers). Most staff (70%) did not agree that the 'blue-card rule' was a helpful concussion policy or should remain within the WAFL. Staff also felt umpires are not qualified to identify suspected concussions on-field (67%). Over two-thirds of medical staff feel the Football Commission needs to provide education about concussion policies before the commencement of each season. Only 33% of medical staff felt completely confident in delivering a sideline assessment, and 17% felt completely confident in their diagnostic capabilities. Relationships between medical and other staff were not substantially impacted by the 'blue-card rule'.

Conclusions: Medical staff within the WAFL reported the 'blue-card rule' as an ineffective concussion identification tool and did not support its continued use for future WAFL seasons. Staff suggested that the Football Commission needs to provide more education on concussion policies before the commencement of each season.

Level of evidence: 3.

Background: Anterior cruciate ligament (ACL) injury and reinjury rates are on the rise, despite improved surgical techniques and prevention programs. ACL injuries also lead to a variety of neuroplastic and neuromuscular alterations. Emerging research highlights the importance of addressing neurocognitive deficits that can persist after injury including altered proprioception, impaired motor control, muscle recruitment and heightened reliance on visual feedback. This suggests a shift from subconscious movement, to movements that require increased volitional control, which may contribute to increased risk of re-injury and thus impede return to sport.

Clinical question: Given the neurophysiological changes associated with anterior cruciate ligament (ACL) injury that persistent into the late stages of rehabilitation, does the integration of neurocognitive training into mid to late stage rehabilitation protocols improve functional outcomes and reduce the risk of re-injury following ACL reconstruction (ACLR) in athletes?

Purpose: The purpose of Part 2 of this clinical commentary is to offer strategies to implement neurocognitive training elements into the traditional ACLR rehabilitation (in weeks 9+) and review updated testing metrics that may better discern an athletes readiness to return to competition. A comprehensive rehabilitation framework incorporating both physical and neurocognitive components is proposed, aiming to improve both long-term outcomes and return to sport testing, as well as diminishing re-injury risk.

Conclusion: Updates to the traditional rehabilitation approach post ACLR, that include increased emphasis on neuroplastic, cognitive, and visual-motor capabilities exist. These help prepare athletes for the unpredictable and chaotic nature of the sporting environment and may facilitate a more effective return to sport for athletes, potentially mitigating the risk of re-injury.

Level of evidence: 5.

Background: Forty-nine percent of overhead athletes suffer from shoulder pain. Throwing movements require the participation of all components of the kinetic chain to reduce risk for shoulder overuse. Thus, limited lower limb range of motion or weakness has been identified as a risk factor for shoulder pain in overhead athletes.

Purpose: This systematic review aims to evaluate the association between shoulder, trunk, and lower limb pain in overhead athletes.

Study design: Systematic Review and Meta-analysis.

Methods: A systematic review was conducted in the PubMed/MEDLINE, Science Direct and CENTRAL/Cochrane databases for observational studies. Search terms included sports-related terms (e.g., 'overhead', 'baseball', 'volleyball', 'handball') and injury-related terms (e.g., 'injury history', 'shoulder pain', 'lower limb pain', 'hip pain', 'knee pain', 'ankle pain', 'foot pain', 'trunk pain'). Studies were considered for review if they met the following criteria: inclusion of overhead athletes, investigation of injury or pain in shoulder and lower limb or trunk, had data related to or could calculate the calculation of odds ratio (OR) or relative risk (RR), available in French or English. The ROBINS-E tool was used to assess the methodological quality of each article. The data were pooled in a random-effects meta-analysis, using odds ratios to estimate the strength of the association between shoulder pain and pain at other locations.

Results: Seven articles were included. Five of them were at moderate risk of bias and two were at high risk of bias. Shoulder pain was associated with low back pain (OR=5.51), hip pain (OR=4.32), knee pain (OR=3.03) and ankle/foot pain (OR=2.84).

Conclusion: This systematic review highlighted, with very low to low certainty, a significant association between shoulder pain and trunk/lower limb pain or injuries.

Level of evidence: Level 3.

Background: Person-centered care is a concept in healthcare that aims to promote the patient's health and adapt resources and interventions based on the patient's needs and wishes. Knowledge on what person-centered physiotherapy is for patients who rehabilitate after an anterior cruciate ligament (ACL) reconstruction, and how patients experience it within the context of sports injury rehabilitation, is lacking.

Purpose: The aim of this study was to explore how patients who were in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced their rehabilitation from a person-centered perspective.

Study design: Qualitative interview study.

Methods: Fourteen patients (57% females), aged 18-57, treated with ACL reconstruction, were interviewed with semi-structured interviews 8-12 months after ACL reconstruction. Interviews were recorded, transcribed and analyzed with qualitative content analysis.

Results: One theme: all lights on me; be seen and heard, a cornerstone for patients, supported by three main categories: 1) rehabilitation: a roller coaster of physical and psychological challenges; 2) patient involvement; 3) the physiotherapist - stronger together; emerged from the collected data.

Conclusion: Patients in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced that the rehabilitation process was person-centered when they felt to be the focus and were allowed to participate via open and constructive communication with the physiotherapists.

Background: Little is known about the influence of kinetic chain strength and power on shoulder problems in handball players or the impact of participation-related shoulder load (PSL) during a season. Suboptimal activity of the kinetic chain during throwing might make the shoulder more vulnerable.

Purpose: The purpose of this study was to assess 1) the association between pre-season measurements and shoulder problems among handball players and 2) whether pre-season strength and power influence the association between PSL and severity of shoulder problems.

Study design: Prospective observational cohort study.

Methods: Pre-season measurements were done using the Isometric mid-thigh pull for lower body strength, a seated test for trunk rotation power (TRP) and isometric testing of external (ER) and internal rotation shoulder strength on 42 male players. Shoulder problems (prevalence, substantial prevalence, and severity score) were documented weekly through a season (31 weeks) with The Oslo Sports Trauma Research Center Overuse Questionnaire (OSTRC-O2) and PSL with the modified Borg rate of perceived exertion scale. Spearman´s correlation coefficient was applied to examine the association within the first aim, while a mixed model ANOVA was conducted to analyze the second aim.

Results: A weak and negative correlation (rs=-0.34) was found between pre-season ER strength and the individual prevalence of shoulder problems (p=0.029). A main effect was found between PSL and the OSTRC-O2 severity score (p=<0.001) with higher severity scores observed with increased PSL. A significant interaction was found between PSL and pre-season TRP regarding their influence on the OSTRC-02 severity score (p=0.017). With higher PSL, a higher severity score was observed among players with pre-season TRP more than one standard deviation below the group's mean.

Conclusions: The results indicate that low TRP may make the throwing shoulder more vulnerable to an increase in load. Looking beyond shoulder strength and load may therefore be important.

Level of evidence: 3.

Background: The Single Leg Bridge Test (SLBT) is commonly described as a measure of 'hamstring endurance'. Nevertheless, the relationship between the SLBT score and isolated hamstring endurance remains uncertain.

Purpose: This study aimed to investigate the correlation between SLBT scores and isolated hamstring endurance in healthy men. Additionally, the study aimed to assess the correlation between the limb symmetry index obtained from the SLBT and hamstring endurance test results.

Design: Cross-sectional study.

Methods: Forty healthy and physically active men were evaluated at the research laboratory on two separate occasions, with a minimum interval of 48 hours between visits. During each visit, participants performed either the single-leg balance test (SLBT) or the hamstring endurance test on an isokinetic dynamometer, which involved 30 concentric knee flexion repetitions performed at maximum intensity, with an angular velocity of 120°/s and a range of motion of 90°. Correlations were analyzed between SLBT scores and hamstring fatigue indexes provided by peak torque and work outcomes.

Results: The SLBT score (27±7 reps) demonstrated no significant correlation with isolated hamstring endurance, as measured by isokinetic peak torque (52±9%; p=0.737, r=-0.038) or work (57±9%; p=0.489, r=0.078). Likewise, the limb symmetry index obtained from the SLBT (99±12%) did not significantly correlate with index from the hamstring endurance test: peak torque (107±26%; p=0.540, r=-0.100) and work (102±18%; p=0.849, r=0.031).

Conclusion: The SLBT does not appear to be a suitable tool for measuring isolated hamstring endurance in healthy men.

Level of evidence: 3.

Background: Traditional methods to measure rotational passive range of motion (PROM) in the throwing shoulder do not reflect the complexity of the throwing motion. Therefore, a sport specific shoulder rotation PROM test (FAST-SHDR) was developed and compared to traditional standard methods to measure shoulder internal and external rotational PROM in the throwing shoulder.

Purpose: The aim of this study was to determine the intra-rater reliability of the FAST-SHDR test in young, healthy, male Division 1 baseball players.

Study design: Reliability and validity analysis.

Methods: A study with 49 healthy participants (31 collegiate baseball players, 18 controls) examined a sport specific shoulder rotation PROM test (FAST-SHDR) and compared this to the standard supine 90/90 shoulder in a single session assessment. Intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Within and between group differences were based on t-tests (p<0.001), absolute differences and effect sizes (95% CIs).

Results: The novel test (FAST-SHDR) had good to excellent reliability with ICCs ranging from 0.95 (0.89 to 0.98) to 0.96 (0.92-0.98). MDC ranged from 7°-11° which is equivalent to 11-14% of mean PROM scores. In the dominant shoulder of baseballers, when FAST-SHDR IR/ER was compared to standard IR/ER testing the FAST-SHDR scores were lower for both IR (MD 23.3°; 95% CI 19.7-26.8) and ER (MD 50.7°; 95% 44.7 to 56.7). Comparing the shoulder rotation PROM in baseballers, the FAST-SHDR ER and IR measurements were significantly lower (p<0.0001) when compared to traditional standard PROM testing for shoulder IR and ER rotation.

Conclusions: FAST-SHDR testing shows good to excellent intra-rater reliability for measuring shoulder rotational PROM and demonstrates both face and discriminant validity.

Level of evidence: 3.

Background: Accurately measuring shoulder strength in overhead athletes is critical, as sufficient strength is essential for safe and sustained performance during repetitive athletic movements. Isokinetic dynamometry (ID) offers dynamic strength assessments that surpass the capabilities of static methods, such as manual muscle testing and handheld dynamometry. The dynamic assessment provided by ID may enhance upper extremity evaluation, aiding in the prediction of injury risk and the determination of return-to-sport criteria for overhead athletes.

Purpose: The purpose of this review was to examine the existing literature concerning the application of isokinetic shoulder strength testing in rehabilitation and clinical decision-making processes among youth athletes who perform repetitive overhead activities.

Study design: Scoping review.

Methods: A comprehensive literature search was conducted using PubMed and EBSCO Host databases, covering publications from 2000-2024. Search terms included "isokinetic dynamometry," "shoulder," and "youth athlete." Inclusion criteria focused on youth athletes (<18 years) engaged in overhead sports, excluding those with neurological conditions or those designated as college or professional athletes. The PRISMA-ScR guidelines were followed.

Results: A total of 23 articles met the inclusion criteria. Volleyball and swimming were the most studied sports, with the most common testing position being the seated 90/90 position. Variations in testing speeds and outcome measures, such as peak torque and external rotation (ER) ratios, were identified.

Conclusions: Isokinetic dynamometry is a valuable tool for assessing shoulder strength in youth overhead athletes. It provides critical insights into muscle strength dynamics, aiding in injury prevention and rehabilitation. Further research is needed to optimize strength assessment protocols and enhance clinical decision-making for safe return-to-sport practices.

Background: Previous injury and physical examination data collected by a physiotherapist were reviewed to investigate the causes of injury among competitive swimmers. Each swimmer received an injury improvement exercise program based on their injury history and physical examination findings.

Purpose: The purpose of this study was to identify trends in the number of shoulder and lumbar injuries and discern the effectiveness of exercise programs in swimmers. The authors hypothesize that these efforts would decrease injury rates.

Study design: Observational Cohort study.

Methods: Thirty-one male high school and college student swimmers underwent a physical examination. Previous injury was considered as pain that lasted for > three weeks or that caused the participant to stop practicing. A questionnaire was administered to all swimmers at the beginning of the study and one year later. The questionnaire assessed the number of injuries sustained and the daily practice hours over the previous year. The injury rate at the first examination and one-year followup was calculated as the number of injury incidents divided by the total number of player hours (1 h of practice is equivalent to 1) for one year, multiplied by 1,000 to obtain the injury rate per 1,000 hours (1000 player hours: 1,000 ph). Shoulder and hip exercise programs were prescribed based on measurement results and previous research.

Results: The numbers of injuries seen in the group were 12 shoulder and six lumbar at the first examination, and two shoulder and one lumbar at the one-year followup. The 1,000 ph (95% confidence interval) values were 0.32 (0.13-0.50) and 0.16 (0.03-0.29) at the first examination and 0.05 (0.00-0.12) and 0.03 (0.00-0.07) at the one-year followup for the shoulder and lumbar areas, respectively.

Conclusions: The results indicates that exercise programs prescribed after a physical examination may reduce the incidence of injuries in male swimmers over the course of a year.

Level of evidence: Level 3.