International Journal of Sports Physical Therapy最新文献

Background/purpose: Anterior cruciate ligament reconstruction (ACLR) often leads to persistent neuromuscular deficits, complicating return-to-sport decisions. Reliable functional assessments are needed to guide RTS after ACLR. The main objective was to examine countermovement jump (CMJ) measures to identify which parameters can best distinguish between ACLR and control participants. The secondary objective was to determine whether performance alterations between operated and non-operated limb exist during CMJ after ACLR.

Design: Non-randomized, single blinded, cross-sectional study.

Methods: Limb symmetry index (LSI) was calculated for vertical ground reaction force (vGRF), maximal power (MP), and eccentric rate of force development (RFDe) during countermovement jumps (CMJ) performed on force plates by an ACLR group (n=64) and a control group (n=47). First analysis compared LSI vGRF, LSI MP and LSI RFDe between groups. Secondary analysis compared vGRF, MP and RFDe between the operated/non-operated limb in the ACLR group and dominant/non-dominant limb in the control group. Between-group comparisons were made using Mann-Whitney tests due to non-normal data distribution. Effect sizes were calculated to assess the magnitude of differences.

Results: Participants included 64 ACLR patients (mean age 26.5 ± 5.0 years; 33 females) and 47 controls (mean age 23.6 ± 2.1 years; 24 females). CMJ measures in the ACLR group were significantly reduced for LSI vGRF (p < 0.001), LSI MP (p < 0.001) and LSI RFDe (p < 0.001). The ACLR group exhibited significant differences between both limbs in terms of vGRF (p < 0.001), MP ( p < 0.001), and RFDe (p < 0.01). No significant limb differences were found in the control group.

Conclusion: Measures of deceleration from the CMJ are altered after ACLR and should be considered throughout rehabilitation.

Level of evidence: 3.

Injuries to the hand and fingers are among the most common injuries in orthopedics and general practice, as they are the part of the human body that interacts most frequently with our environment. Diagnostic musculoskeletal (MSK) ultrasound offers a portable, real-time, and cost-effective alternative that is very useful for obtaining information about small structures like the finger extensor tendons. MSK ultrasound is adept at detecting changes in both tendon tissue composition and integrity. This manuscript will review the utility of MSK ultrasound in evaluating finger extensor tendons and include a review of its anatomy, common injury patterns, sonographic techniques, and clinical implications for professional rehabilitation. By integrating MSK ultrasound into clinical practice, providers can improve the accuracy of diagnosis, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to optimal patient outcomes.

Background: Poor lumbopelvic-hip control has been linked to higher shoulder and elbow joint moments and injury risk in collegiate and professional baseball pitchers. The purpose of this study was to investigate if lumbopelvic-hip control was correlated with shoulder and elbow joint moments and drive leg ground reaction force (GRF) in high school baseball pitchers. The hypothesis was that poorer lumbopelvic-hip control would be correlated with higher joint moments and lower drive leg GRF. Study design: Cross-sectional study.

Methods: Lumbopelvic-hip control was assessed based on the anterior-posterior pelvis angular displacement using the single-leg lift test (SLLT) on each limb. Peak shoulder horizontal adduction and internal rotation and elbow varus moments during pitching were calculated using inverse dynamics. The correlations between lumbopelvic-hip control and the biomechanical variables (i.e., normalized joint moments, peak anterior GRF, and anterior GRF impulse) were analyzed.

Results: Sixty healthy high school pitchers (age: 15.8 ± 1.3) recruited from local baseball training facilities participated. The lumbopelvic-hip control while standing on the drive leg had a moderate correlation with the peak shoulder horizontal adduction moment during pitching (r=.301, p=0.02) but not with peak shoulder internal rotation moment (p=0.19), elbow varus moment (p=0.95), peak anterior GRF (p=0.95), or anterior GRF impulse during the drive (p=0.61). Lumbopelvic-hip control while standing on the lead leg was not correlated with any variables.

Conclusions: Poorer lumbopelvic-hip control was moderately correlated with greater shoulder horizontal adduction moment during throwing among high school baseball pitchers. These results support and extend the understanding of the influence of lumbopelvic-hip control on pitching mechanics in high school-aged pitchers.

Level of evidence: Level 3.

Background: Dry needling (DN) has emerged as a safe and effective physical therapy technique to address neuromusculoskeletal pain and dysfunctions; however, a gap in the literature exists regarding the experience from the patient's perspective, with most studies focusing on clinician-reported outcomes.

Purpose: The purpose of this study was to investigate patients' perspectives of self-reported adverse events and clinical outcomes from DN within the first 24 hours following the technique.

Study design: Cross-sectional retrospective study.

Methods: From April to May 2022, 123 participants were recruited through word of mouth, university-wide emails, and social media to complete an electronic survey. Inclusion criteria included those >18 years of age and who had received DN in the prior three months by a licensed physical therapist. The survey consisted of three sections: knowledge and experience with DN, location and perceived effects of DN, and participant demographics. Perceived effects focused on localized (e.g., pain, soreness, bruising) and generalized adverse events (e.g., shortness of breath, fatigue, fever), as well as outcomes (pain, gait, strength, mobility). Descriptive statistics were used for participant demographics and item responses.

Results: One hundred twenty-three participants completed the electronic survey (77.2% aged 18-50 years; 53.7% female). Soreness (52.0%) and pain (33.0%) were the most reported localized adverse events. Fatigue (21.7%) and headache (15.4%) were the most reported generalized adverse events. Following DN, patient-reported improvements in pain occurred in 73.8% of the selected body regions, while improved mobility occurred in 70.6%, improved strength in 38.5%, and improved gait in 46.2%.

Conclusion: Practitioners who utilize DN have a responsibility to communicate the possible benefits and adverse events post-DN. At least one localized event was reported in over 80% of the cases and one generalized adverse event in 40%, while positive improvements in pain or physical impairment occurred 38.5-73.8% of the time. Taken together, patients' self-reported benefits and adverse events in response to DN should both be carefully considered and discussed by practitioners when making clinical decisions about its use as a therapeutic intervention.

Level of evidence: 3.

Background: Baseball players and coaches may not have the personnel resources to monitor the pathological declines in shoulder function throughout the season. The ArmCare Strength and Range of Motion Sensor and Mobile Application (ArmCare testing system) was designed to allow players to test and monitor their shoulder range of motion (ROM) and strength.

Purpose: To establish the reliability and concurrent validity of the ArmCare testing system for measuring ROM and strength in high school and college baseball players.

Study design: Cross-sectional.

Methods: Fifty-one baseball players self-tested their shoulder ROM and strength using the ArmCare testing system protocols and instructional video guidance. Participants repeated the testing following a 30-minute washout period and were blinded to their results. Intra-rater reliability measures were established by comparing ArmCare testing system scores between two same-day trials. Concurrent validity was assessed by comparing ArmCare testing system ROM and strength measures with standardized goniometric ROM and hand-held dynamometry measures performed by clinicians who were blinded to the results. Intraclass correlation coefficients (ICC) were used to assess the intra-rater reliability of the ArmCare self-testing system and Pearson correlation coefficients evaluated the concurrent validity among goniometric ROM and strength dynamometry.

Results: Intra-rater reliability ranged from poor to moderate (0.19 to 0.67) for AROM and moderate to good (0.73 to 0.87) for strength measures. For validity, poor overall agreement (ICC = 0.17 to 0.37) and correlation (r = 0.23 to 0.47) was found between the ArmCare testing system and all shoulder AROM measures. The ArmCare testing system demonstrated moderate to good agreement (ICC = 0.72 to 0.79) and correlation (r range = 0.72 to 0.81) compared to dynamometry for all strength measures.

Conclusion: The ArmCare testing system may be a reasonable self-guided examination for high school and college baseball players to measure shoulder strength. However, ROM testing using the ArmCare testing system lacks consistency and accuracy warranting further investigation.

Level of evidence: Level 3.

Background and purpose: Emergency medical service and critical care transport teams are considered tactical athletes due to the significant physical demands of their job. Injury rates are high in these populations. A lack of proper physical fitness puts individuals and their team members at risk of injury and may create risk of inadequate care in emergency situations. The University of Wisconsin (UW) Med Flight team identified the need to implement physical testing as a condition of employment and annual compliance. The purpose of this case report was to develop and implement a physical ability test for a med flight team. # Methods Members of the University of Wisconsin Health (UW Health) Sports Rehab department collaborated with the UW Med Flight team. The coordinator of the Sports Rehab Tactical Athlete Specialty Clinic performed an onsite assessment to evaluate the distances and heights traveled, size and weight of equipment managed, and duties of providers who are part of the critical care transport team. Analysis of other institutions' testing procedures was performed via online searches and professional communication. Pilot practice sessions of the assessment were performed. Practice sessions and town hall meetings were offered to the staff. The new health assessment referenced as the Med Flight Physical Ability Test (MFPAT) commenced in January 2023.

Results: Sixty-nine of 71 team members passed the MFPAT. One team member did not pass due to a known knee condition that limited her physical abilities. An incoming med flight physician fellow failed to pass the test due to a recent hand injury.

Discussion: While other critical care transport physical ability tests exist, there is an overall lack of industry wide testing procedures, nor have these tests been widely published. Without this standard, a critical care transport team lacks accountability of crew members to maintain adequate fitness levels needed for their positions. Therefore, the MFPAT was developed to establish a physical assessment for a specific med flight team. The development and application of such a test could set a precedent for other institutions.

Level of evidence: 4.

Background: The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is a valid and reliable test commonly used during return to sport testing. While reference values have been determined for multiple sports, few have specifically considered National Collegiate Athletic Association (NCAA) American football players.

Purpose: To provide reference values on the CKCUEST for NCAA football players with considerations for position, history of upper extremity injury, year in school, and division of college football.

Study design: Cross-sectional study.

Methods: Eighty football players from three NCAA schools were recruited to participate in this study. Height, mass, position, year in school, and history of upper extremity injury were collected. Subjects completed three trials of the CKCUEST with their means recorded. Means were compared using ANOVA with post hoc Bonferroni tests. A T-test was used for a secondary comparison of mean touches of linemen versus all other positions. Pearson correlation coefficients assessed the relationship between number of touches and subject characteristics.

Results: Subjects were all males with a mean of 2.5 years in school (95% CI 2.18-2.85). Subjects of the study averaged 27.3 touches. There were no statistically significant performance differences between players from NCAA divisions, with/without injury history, years in school, or athlete demographics. Linebackers had significantly more touches compared to offensive linemen, 29.7 and 24.8 (p<0.03), respectively. Additionally, linemen as a group (offensive and defensive) averaged 25.7 touches, which was significantly lower compared to all other positions combined (28.1 touches, p<0.01). The minimal detectable change was 1.2 touches.

Conclusion: A reference value of 27 touches was found for the CKCUEST in NCAA football players. A change of at least two touches would indicate a measurable change. Position differences should play a role in clearance for return to sport; specifically, linemen may produce less touches than other non-lineman positions.

Level of evidence: Level 2c: Cross-sectional study.

Background: Reported rates of return to sport at prior levels (RTSP) and recurrent instability are varied after anterior shoulder stabilization procedures and standardized criteria for clearance decision-making are lacking.

Purpose: To 1) describe the current state of RTSP and recurrence rates for competitive athletes undergoing the most frequently performed anterior shoulder stabilization procedures and the factors potentially associated with these outcomes and to 2) describe RTS clearance timeframes and how RTS clearance decisions were made in the included studies.

Study design: Scoping review.

Methods: A systematic literature search over the past 10 years was conducted using the MEDLINE, EMBASE, and OVID databases to find articles that analyzed RTSP and recurrent instability with at least two-year follow-up in competitive athletes after common anterior shoulder stabilization procedures. The Methodological Index for Non-randomized studies (MINORS) scale was used to assess study quality.

Results: Twenty-nine articles were included, analyzing a total of 2,237 shoulders in 2,187 competitive athletes. Overall, 82.3% were able to RTSP and 7.0% had recurrent instability. For those undergoing Bankart repair, the RTSP rate was 79.7% and 9.2% had recurrent instability. For the Latarjet procedure, these rates were 87.4% and 3.1%, respectively. Reported times for return ranged from 11 weeks to 8.4 months and ten unique criteria for clearance were identified by the included articles. Strength and range-of-motion (44.8% each) were the most common criteria. The average MINORS score for non-comparative studies was 8.58 ± 1.35 (maximum score of 16). For comparative studies, the average MINORS score was 14.00 ± 1.56 (maximum score of 24).

Conclusion: Competitive athletes may RTSP at relatively high rates after anterior shoulder stabilization. However, high-level prospective evidence is lacking and there is a need to standardize clearance decision-making processes and reporting in the literature.

Level of evidence: Level 4 (Scoping Review).

Background: In handball, injury occurs more frequently during actual games than during handball practice. However, mechanical loading during actual games is unknown.

Purpose: The purpose of this study was to describe body impact characteristics during handball games using accelerometers, and to investigate sex differences in these characteristics.

Study design: Comparative observational study.

Methods: Acceleration data were measured during practice games in 24 high school handball players (12 males, 12 females). The acceleration was set to 1 gravitational acceleration (G) when each axis direction was aligned with the direction of gravity during data collection. High-impact movements with a resultant acceleration of ≥ 6G were extracted, and video images was used to identify movements and plays during which the high-impact movements occurred. The number of cases, percentage, frequency (cases/min ･ person), and 95% confidence interval of the frequency were calculated for the movement classification, play classification, and movement classification × play classification. The peak acceleration values of resultant accelerations of ≥ 6G were also obtained.

Results: The frequencies of resultant acceleration ≥ 6G were 5.3 cases/min ･ person for males and 4.7 cases/min ･ person for females. Deceleration and sprinting were the most frequent motion categories in both sexes. High-impact movements were more frequent in fast attack-related play in males and attack-to-defense transitions in females.

Conclusion: High-impact movements are more frequent in plays related to fast attacks in males and when switching from attack to defense in females. High-impact movements are more likely to occur during the switch from attack to defense in females.

Level of evidence: 3.

Graduate healthcare students may have athletic backgrounds with history of concussion. Since these students spend much time multi-tasking while guarding, transferring, and treating patients in clinical settings, understanding the potential impact of external factors on dual-task abilities may help better equip them for success. # Purpose The purpose of this study was to explore the relationship between concussion history, concussion education, and athletic history on academic performance and different single- and dual-task assessments among graduate healthcare students. # Study Design A cross-sectional, repeated measures study. # Methods A convenience sample of 33 graduate healthcare students, between the ages of 21-31 years old, were recruited from a health sciences institution. Inclusion criteria included enrollment at the institution and being between the ages of 18 and 35 years old. Exclusion criteria included a concussion within the past 30 days, current post-concussion symptoms, an upper and/or lower extremity injury, and/or pregnancy. Investigators collected subjective sport, concussion, and academic history before data collection. Then, participants were randomly assigned to perform single- and dual-task cognitive and walking activities. Parameters of gait and cognitive activity scores were measured to calculate dual-task cost (DTC). Next, principle component analyses were conducted to incorporate all measured variables into a single model for linear regression. Linear regressions were used to model the relationships between sport and concussion history and each component. # Results Data were collected for 32 participants (aged 25 ± 2.46 years). A lack of concussion history was a significant predictor for experiencing greater DTC for performing a memory/recall task while walking backward. Additionally, lacking formal concussion education was a significant predictor for a higher DTC associated with the visuospatial task while walking backward. Finally, a longer history of athletic play predicted a lower undergraduate GPA. # Conclusions Lacking concussion history and education as well as having a longer athletic history significantly predicted aspects of DTC and academic achievement in graduate healthcare students. These data may influence future decision-making criteria and processes when supporting and guiding students with athletic backgrounds through healthcare education programs involving psychomotor activities. Further studies with a larger sample and control for plausible confounding variables may provide additional insight. # Level of Evidence 2b.