International Journal of Sports Physical Therapy最新文献

Postural control deficits are common among children with and without disabilities. Performance-based postural control tests provide both quantitative and qualitative insights into the severity of these deficits but are underutilized in clinical practice. Digitizing existing postural control tests could increase their overall implementation. # Purpose This study examined the feasibility and validity of 'Matti', a pressure-sensitive device, as a tool for recording simple continuous data for two performance-based postural control subtests: the time in seconds during the One-Board Balance Test (OBBT) and the number of jumps during the Lateral Jump Test (LJT), in typically developing children. # Study Design Cross-sectional study # Methods Both conventional and digitized versions of both the OBBT and LJT were administered. The conventional test condition was rated by an observer, while the digitized version was scored by both an observer and analysis software using Matti's sensor data. Correlation analyses, comparisons of the mean or median, and Bland-Altman plots were used to assess concurrent validity and level of agreement between conventional and digitized test conditions, as well as between observed and digital outcomes of the digitized test condition. The level of enjoyment between conventional and digital testing was evaluated using a Smiley-o-Meter. # Results Forty-six children (average age 8.98 (±1.04) years, 10 female) participated in this study. Digitized testing showed strong correlations between digital and observer-based outcomes for both the digital OBBT (rs=.991, p<0.001) and LJT (r=.962, p<0.001). However, differences were noted between conventional and digitized conditions. Participants reported significantly higher levels of enjoyment during digital testing (Z=-2.530; p = 0.011). # Conclusion The Matti demonstrates good feasibility for a simple digitized performance-based postural control test. However, differences between the scores of conventional and digitized test conditions indicate a lack of concurrent validity with conventional clinical tests. The higher perceived enjoyment reported during digital testing suggests its potential as a valuable tool in pediatric postural control assessment and rehabilitation.

Background: Deficits in shoulder strength have been previously established as a risk factor associated with the development of time-loss shoulder and elbow injuries. However, limited data exists on normative shoulder strength changes in collegiate baseball athletes over the course of a competitive season. Hypothesis/Purpose: There were two purposes of this study: 1) to assess changes in shoulder strength over a competitive season, and 2) to assess self-perceived shoulder and elbow function changes over the course of a competitive season in healthy Division I collegiate baseball players. It was hypothesized that shoulder strength would differ over a competitive season with no observed differences in Kerlan-Jobe Orthopaedic Clinic (KJOC) scores over time in healthy baseball athletes.

Study design: Prospective cohort.

Methods: Forty-nine uninjured NCAA baseball athletes were assessed for bilateral isometric shoulder strength (external [ER] and internal [IR] rotation and scaption [SCAP]) via handheld dynamometry at four time points: fall physicals, preseason, mid-season, and postseason. Additionally, athletes completed the KJOC score at each testing session. A 2x4 repeated measures multivariate analysis of variances was conducted to determine the effect of playing position and time on normalized shoulder strength and KJOC scores.

Results: There was a main effect of time on isometric shoulder strength (p < 0.001). There was no effect for position (p = 0.88), or interaction effect of position and time (p = 0.643). Pairwise comparisons demonstrated differences across time in dominant limb ER (p = 0.01) and SCAP (p < 0.001), and non-dominant limb ER (p < 0.001), IR (p = 0.004) and SCAP (p < 0.001). There were no differences over time for dominant limb IR (p = 0.131) or KJOC scores (p = 0.154).

Conclusion: Uninjured collegiate baseball players demonstrated changes in shoulder strength over time that exceeded minimal detectable change scores over the course of a competitive season for both limbs. The results of the present study offers shoulder strength values using a reliable and reproducible normalization method to evaluate shoulder strength in collegiate baseball athletes.

Level of evidence: III.

Background: Low-load blood flow restriction training (LL-BFRT) has been suggested as an alternative to heavy-load resistance training (HLRT) following anterior cruciate ligament (ACL) reconstruction. While current research primarily focuses on the clinical outcomes of LL-BFRT and HLRT, patients' experiences with these rehabilitation methods remain unexplored. Such an exploration may provide insights that can contribute to more patient-centered rehabilitation approaches.

Purpose: This study aims to explore patients' experiences with strength rehabilitation using LL-BFRT or HLRT following ACL reconstruction. Study design: Qualitative Cohort study.

Methods: Patients who had undergone primary bone-patellar tendon-bone ACL reconstruction and completed an LL-BFRT or HLRT protocol within the prior six months were contacted to participate in semi-structured interviews. All interviews were audio-recorded, transcribed verbatim, and anonymized. An inductive thematic analysis was conducted to identify key themes and patterns.

Results: Ten participants were interviewed, with five in the LL-BFRT group and five in the HLRT group. The interviews were conducted, on average, four months after completion of the strength rehabilitation protocol. The inductive thematic analysis revealed four main themes: experiences with strength training, perceived benefits, challenges encountered, and impact on the recovery process. All participants experienced progression in muscle strength. Three participants in the LL-BFRT group reported thigh muscle pain, whereas four participants in the HLRT group noted knee pain during strength rehabilitation. Overall, participants had positive views on their recovery process, except for two participants in the HLRT group who reported negative effects on their recovery due to persistent knee pain.

Conclusion: The results of this study highlights patients' experiences with LL-BFRT and HLRT following ACL reconstruction. The findings indicate that LL-BFRT may be suitable in the early rehabilitation phase, as knee pain in the HLRT group may negatively affect the recovery process.

Level of evidence: NA.

Performance enhancement and injury risk reduction are crucial for youth elite athletes. The pursuit of both these goals remains challenging in team sports as individual needs must be balanced with collective training goals. Despite the available evidence on screening, maturation, monitoring, and staff involvement, the optimal approach for enhancing performance while reducing injury risk in young athletes has yet to be defined, and integrating evidence into clinical settings remains a significant challenge. This clinical commentary aims to share the decision-making process regarding performance enhancement and injury reduction in volleyball players within a youth elite sports school, considering maturation and a context of limited budgets for the use of advanced monitoring tools. A youth elite sports school offers a structured environment that allows young athletes, aged 12-18, to combine education with a sport-specific elite athletic development program supervised by a multidisciplinary team. The authors address challenges related to preparticipation screening, maturation differentiation, low-budget monitoring, and communication. Based on literature, the daily experiences and project outcomes, opportunities for an integrated approach are identified which offer scalable, evidence-informed solutions to optimize performance development. # Level of Evidence 5.

Most anterior cruciate ligament (ACL) tears occur during non-contact, deceleration phases of sports activity. Injury risk screenings use the drop vertical jump (DVJ) to assess landing mechanisms, but no researchers have examined biomechanical differences between the first and second landings in youth athletes following ACL reconstruction. # Purpose The purpose of this study was to compare biomechanical risk factors in the first and second DVJ landings in both the surgical (affected) and unaffected limbs in youth athletes recently cleared for RTP following ACL reconstruction. # Study Design Cross Sectional # Methods A total of 58 youth athletes (37 females, 21 males; 15.9 ± 1.9 years; 164.0 ± 9.5 cm; 66.0 ± 15.3 kg) who had undergone ACL reconstruction (ACLR) and were granted return to play (RTP) clearance from their physician participated in this study between 2020 and 2024. Kinematic and kinetic data using 3-Dimensional motion capture were collected while participants performed a series of dynamic tasks which included a DVJ with standardized instructions. Wilcoxon signed-rank tests were performed to determine significant differences between the first (1st) and second (2nd) DVJ landings, as well as between the affected (AFF) and unaffected (UNAFF) limbs. Effect sizes (r) were computed for all significant comparisons. A Holm-Bonferroni correction was applied within each comparison group due to multiple comparisons. # Results There were greater biomechanical risk factors associated with dynamic knee valgus during the first landing, including knee valgus (AFF: p<0.001; UNAFF: p=0.001), hip internal rotation (AFF: p<0.001; UNAFF: p<0.001), knee external rotation (UNAFF: p<0.001). Overall, there were more significant biomechanical risk factors in the unaffected limb compared to the affected limb in both landings. A stiffer landing, with less trunk flexion (AFF: p<0.001; UNAFF: p<0.001), knee flexion (AFF: p<0.001; UNAFF: p<0.001), and hip flexion (AFF: p<0.001; UNAFF: p<0.001) was observed in the second landing. # Conclusion More biomechanical risk factors occurred during the first landing of the DVJ, with more risk factors present in the unaffected limb during both landings. These findings highlight the need for a comprehensive DVJ assessment of both landings and both limbs for evaluation of RTP readiness following ACL reconstruction. # Level of Evidence III.

Health and physical activity are important for sport injury prevention in athletes. A clinical seminar session at the World Physiotherapy Congress 2025 in Tokyo highlighted the need for sports physiotherapists to identify and address risk factors, design individualized prevention programs, and use their expertise when working with athletes. The purpose of this perspective article is to revisit the content of that seminar and encourage the employment of primary, secondary, and tertiary prevention strategies to positively affect athlete health and ensure sustainable performance among athletes.

Level of evidence: 5.

Background: Altered knee joint loading is pervasive and persistent after anterior cruciate ligament reconstruction (ACLR) and a significant driver for the development of knee osteoarthritis (OA).

Purpose: To describe a prospective, parallel, randomized controlled trial aiming to evaluate the efficacy of an eight-week squat visual biofeedback program implemented early after ACLR.

Study design: Randomized controlled clinical trial.

Methods: Thirty-four individuals (13-35 years of age) will be recruited for a prospective, parallel, randomized controlled trial. Embedded within progressive, criterion-based post-operative physical therapy, participants will be randomly allocated to an eight-week bodyweight squatting program either with or without visual biofeedback initiated when 50% weightbearing is allowed by the treating surgeon. Outcomes will be measured at pre- and post-intervention, six months post-ACLR, and nine months post-ACLR. The primary outcomes are 1) change in knee flexion moment impulse interlimb ratio during squatting at post-intervention, and 2) change in cartilage microstructure from pre-intervention to six months. Secondary outcomes include 1) knee flexion moment impulse interlimb ratio during squatting at six months post-ACLR, 2) peak knee flexion moment interlimb ratio during gait at post-intervention and six months post-ACLR, and 3) quadriceps strength at post-intervention and six months post-ACLR. Exploratory outcomes include knee range of motion and effusion, single-legged hop tests, daily physical activity, additional movement biomechanics, and patient-reported outcomes.

Discussion: This study will assess the efficacy of an eight-week squat visual biofeedback program implemented early after ACLR. Findings will inform the future development and testing of comprehensive knee loading rehabilitation interventions that seek to optimize both the magnitude and frequency of knee joint loading to prevent early knee OA after ACL injuries.

Level of evidence: NA.

Trial registration: Clinicaltrials.gov reference: NCT05363683. Registered May 6, 2022.

Background & purpose: The Latarjet procedure is a well-established method for surgical stabilization in the case of recurrent anterior shoulder instability. The purpose of this case report was to describe the post-operative physical therapy progression and outcome of a Division I women's basketball player following an open Latarjet procedure. # Case Description The subject was a 23-year-old female Division I collegiate basketball player who had experienced multiple shoulder dislocations during basketball-related activities. Initial management consisted of six weeks of physical therapy. However, the subject reported continued instability and underwent a right shoulder arthroscopic anterior labral repair (Bankart) and returned to sport eight months post-surgery. Following her return, the subject sustained multiple recurrent shoulder dislocations during practice. The subject then underwent an open Latarjet procedure. Physical therapy interventions followed a sequential and multi-phased approach based on time for tissue physiologic healing and individual progression. Subject reported outcomes including the Pennsylvania Shoulder Score (PSS), Quick DASH, the single assessment numeric evaluation (SANE) and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) were assessed in addition to isokinetic strength and performance testing to determine return to sport readiness. # Outcomes The subject completed 30 sessions of physical therapy over 16 weeks. Clinically meaningful improvements were observed in subject reported outcomes at return to sport, including the PSS, QuickDASH, SANE, and OSPRO-YF. Additionally, improvements in shoulder strength, endurance, power, and performance measures exceeded thresholds of clinical significance. Follow-up imaging (CT and radiographs) showed osseous mineralization with no acute abnormalities. # Conclusion The subject of this case report returned to full sports participation following a Latarjet procedure at five months post-operative. Rehabilitation following a Latarjet procedure in a female overhead athlete presents several challenges.

Level of evidence: Level 5.

Proprioceptive Neuromuscular Facilitation (PNF) has deep roots in neurological rehabilitation for the treatment of neuromuscular disorders that has carried over into musculoskeletal rehabilitation and human performance. There are two major aspects of PNF in musculoskeletal practice, stretching and strengthening, but this commentary only addresses the effects of strengthening. Techniques that do not incorporate all the original principles and guidelines as described in the literature are often miscategorized as PNF. The purpose of this clinical update/commentary is to review the essential principles, guidelines, and techniques for the effective utilization of PNF strengthening exercises for the upper extremity highlighting the importance of regaining/maintaining the synergist relationship between the glenohumeral joint and scapula. It will also provide recommended sequencing, exercise parameters, and present evidence of the effectiveness of incorporating PNF patterns into the rehabilitation programs for upper extremity pathologies. # Level of Evidence 5.

Background: Hamstrings atrophy is widely reported following anterior cruciate ligament reconstruction (ACLR) with hamstrings tendon (HT) autograft. Nordic hamstring exercise (NHE) has yielded improvements in hamstrings volumes among uninjured individuals, yet this has not been investigated following ACLR.

Purpose: To describe changes in hamstrings volumes following an isolated NHE protocol among individuals with a history of ACLR via HT.

Study design: Prospective case series.

Methods: Individuals (age 18-35) with primary, unilateral ACLR via HT was recruited from an a larger clinical trial. Participants were not engaged in formal rehabilitation at enrollment. Outcomes were assessed in a university research laboratory and medical center. Involved limb muscle volumes were quantified for the total hamstrings, biceps femoris long head, biceps femoris short head, semimembranosus, and semitendinosus via magnetic resonance imaging before and after a standardized, progressive four-week (10-session) NHE protocol. Average peak eccentric force was quantified using a NordBord dynamometer during the first and last exercise sessions. Change scores were reported descriptively as percentages (%) and their magnitudes were quantified using effect sizes (Cohen's d).

Results: Seven individuals participated (age: 22.0±2.3 years, time from surgery: 53.6±29.5 months). Volumetric changes ranged -6.0 to 17.6% across participants and muscles. On average, trivial-to-moderate magnitude increases in hamstrings volumes (3.3-7.2%, d=0.12-0.53) were observed, except for semimembranosus (0.0%, d=0.01). Changes in eccentric force ranged -3.2 to 19.4% across participants. On average, a moderate magnitude increase in force (11.0%, d=0.53) was observed.

Conclusion: The majority of participants in this case series demonstrated trivial-to-moderate increases in hamstrings muscle volumes in parallel with a moderate increase in eccentric force after four weeks of isolated NHE. Variable responses to exercise appear to support the need for individualized exercise prescription in this population.

Level of evidence: 4.