International Journal of Sports Physical Therapy最新文献

Background: Trunk rotation during pitching correlates with pitching velocity and load on the joints of the upper limb. Trunk rotation is often focusing on during teaching the pitching motion. Athletes who exhibit early trunk rotation during pitching often have low thoracic spine rotational range of motion. The purpose of this study was to investigate the relationship between the range of thoracic spine rotation measured using the lumbar locked rotation test (LLR-t), hip-shoulder separation (H/S) and thoracic rotation angle at stride foot contact (SFC), and ball velocity.

Study design: Descriptive laboratory study.

Methods: Fifteen healthy male high school students belonging to a baseball club were recruited for participation. The throwing side and non-throwing side LLR-t was performed using an inclinometer. Hip-shoulder separation and thoracic rotation angle during SFC were measured using a pitching motion analysis application: Pitch AI. In addition, a tracking device specifically designed for pitching：Pitching2.0 was employed to measure ball velocity. Correlations between LLR angle, H/S, trunk rotation angles at SFC, and ball velocity were examined using Pearson's correlation coefficient.

Result: There was a positive correlation（r=0.52，p=0.047） between the LLRt angle and H/S. Additionally, there was a negative correlation（r=-0.62, p =0.01） between the LLRt angle on the throwing side and thoracic rotation angle. There was a positive correlation(r=0.54, p=0.04) between ball velocity and H/S and a negative correlation(r=-0.56, p=0.03) between ball velocity and thoracic rotation angle during SFC. 　.

Conclusion: The LLR-t measures thoracic rotation angle with the pelvis-lumbar spine fixed. The results indicated that throwing side LLR was related to the thoracic angle during SFC and hip-shoulder separation.

Level of evidence: 3.

Background: Rehabilitation following traumatic knee injury often focuses primarily on physical aspects. Lack of knowledge of psychological factors and appropriate strategies may be a barrier to meeting treatment recommendations to address these factors.

Purpose: The aim of this study was to investigate whether, and to what extent, Scandinavian physical therapists address psychological factors in treatment of physically active people with traumatic knee injury.

Study design: Cross-sectional online survey study.

Methods: This 32-item study-specific online survey examined physical therapists' use of goal-setting, imagery, and arousal regulation to address psychological factors during rehabilitation following traumatic knee injury.

Results: Results from n=143 physical therapists indicate that they consider it very important to use goal-setting (median 4 [IQR 1]), imagery (median 4 [IQR 1]), and stress management (median 4 [IQR 1]) during rehabilitation on a scale of 1 (lowest) to 5 (highest). Goal-setting was used by n=143 (100%); imagery by n=67 (47%), and arousal regulation by 76 (53%). Lack of knowledge was the most commonly cited reason for not using imagery (n=61; 43%) and arousal regulation (n=55; 38%). Participants rated workshops, courses, or formal education as the most useful methods of learning to use psychological skills training in clinical work.

Conclusion: Goal-setting is commonly used by Scandinavian physical therapists. However, only approximately half of participants report using imagery and/or arousal regulation in knee injury rehabilitation. This may indicate that best-evidence recommendations for treatment are not being met. Future research should explore methods for providing education and practical strategies for encouraging clinical use of psychological interventions.

Level of evidence: 3.

Background: This study implemented the Copenhagen Adductor Exercise (CAE) and Nordic Hamstring Exercise (NHE) to examine 1) whether CAE and NHE interventions are associated with adductor and hamstring strength gains in youth African male soccer players and 2) whether strength changes after a rest period and secondary intervention.

Study design: Pre-post intervention study.

Methods: Forty-four African elite male academy players (age 14.7±1.5 [12-18] years) participated in twice weekly CAE and NHE interventions for 8- and 10-week periods separated by a 4-week rest. Long lever adductor squeeze strength and prone isometric hamstring strength were measured with mixed-effects linear regression models to observe strength changes over time.

Results: Ninety-six and 95% of CAE and NHE sessions were completed in each intervention, with no adverse events related to the execution of the exercises. Adductor squeeze strength increased during the first intervention (baseline 3.23 [2.99-3.47] N/kg, post-intervention 3.53 [3.30-3.76] N/kg, p=0.911) and was maintained following the rest period (3.52 [3.27-3.76] N/kg, p=0.999) and second intervention (3.60 [3.35-3.84] N/kg, p=0.002). Hamstring strength improved during the first intervention (baseline 4.95 [4.42-5.49] N/kg, post-intervention 5.48 [4.95-6.02] N/kg, p<0.001), decreased to baseline during the rest period (4.98 [4.44-5.53] N/kg, p=0.996), and did not improve during the second intervention (5.01 [4.46-5.55] N/kg, p=0.978).

Conclusion: CAE and NHE interventions can be implemented at an elite African academy with high compliance. Adductor and hamstring strength improved in the first intervention, with no further improvements in the second intervention. Secondary interventions therefore should include higher exercise volume or load to improve longitudinal adductor and hamstring strength.

Level of evidence: Level III (Cohort Study).

Background: The seated wall angel (SWA) is an intervention to improve upper quarter mobility but has not been described as a clinical test with scoring.

Hypothesis/ purpose: To explore the clinical utility of the SWA as a test with scoring. The authors hypothesized that SWA test scores would be lower on the injured than uninjured side, improve over time, and show stronger association with patient-reported shoulder function than shoulder mobility tests.

Study design: Prospective cohort.

Methods: Patients diagnosed with anterior shoulder instability and referred to physical therapy participated. Testing occurred after physical therapy examination (initial) and six weeks later (follow-up). Rehabilitation was not controlled. Testing included clinical tests (SWA, passive shoulder external rotation range of motion, total arc of motion) and patient-reported outcomes including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, (ASES) and the Western Ontario Shoulder Instability Index (WOSI). The SWA test was scored 0 to 3 points bilaterally based on number of body contacts with the wall (i.e., elbows and fingertips, posterior fingers, posterior forearm). Passive range of motion was measured with a standard goniometer. SWA scores were compared between sides at initial testing and compared between testing timepoints on the injured side. Associations among injured side clinical test values and patient-reported outcome scores were examined.

Results: Mean (SD) SWA score on the injured side was significantly lower than the uninjured side at initial testing [1.6 (1.0) vs 2.2 (1.1), p = 0.045] and significantly increased at follow-up testing [2.4 (1.0), p = 0.041]. Only SWA test score was significantly correlated with ASES (r=0.597) and WOSI (r=-0.648) scores at initial testing, and SWA test score was significantly correlated with WOSI score at follow-up testing (r=-0.611).

Conclusions: The clinical utility of the SWA test is supported by distinguishing the injured and uninjured sides and having stronger associations with patient-reported shoulder function than shoulder mobility tests.

Background: There is a large population of young athletes who participate in gymnastics, and the prevention of injury in junior athletes is considered important. However, few studies have prospectively investigated the relationship between physical factors and the occurrence of injury.

Purpose: To investigate the physical characteristics that are factors in the injury occurrence in elementary and junior high school gymnasts.

Study design: Prospective observational study.

Methods: A total of 36 healthy young gymnasts (at national competition level) were enrolled in the study. Once a week for 23 weeks, injuries were prospectively investigated using self-report questionnaires under the supervision of a research staff. Joint range of motion (hip, ankle, shoulder, and wrist), tightness (Thomas test, Ely test, straight leg raise [SLR], triceps surae, combined abduction test [CAT], horizontal flexion test [HFT]), and muscle elasticity (multifidus) were assessed to compare differences in physical function between injured and non-injured participants.

Results: Injuries occurred most commonly in the wrist (42.1%), lower back (30.2%), and foot (9.5%) among males, whereas heel (22.2%), knee (16.0%), and lower back (12.8%) were the most common injury sites among females. Wrist injuries in male athletes showed decreased shoulder joint range of motion, and lower back injuries showed decreased hip and shoulder joint range of motion. Lower back injuries in female athletes showed decreased hip extension mobility. Heel and knee joint injuries in females also showed increased range of motion and decreased tightness.

Conclusions: The results of this study indicate that the factors related to flexibility differ according to injury location. Further studies are required to clarify the physical factors that influence injury occurrence by examining the effects of the gymnasts' muscle strength, age, individual factors, and left-right differences.

Level of evidence: 3.

Anterior cruciate ligament (ACL) injuries are complex and influenced by numerous internal and external risk factors that should be considered to effectively mitigate injury and facilitate informed return to sport decision-making. Among these risk factors, movement quality exhibited during sport-specific tasks has been identified as a significant predictor of injury occurrence. Particularly, change of direction (COD) movements, when performed with sub-optimal movement quality, such as knee valgus and lateral trunk flexion, are prominent mechanisms of ACL injury in multidirectional sports. Unfortunately, the formal and objective assessment of COD movement quality is underutilized in clinical and sports practice, with existing methods often confined to expensive, sophisticated laboratory settings impractical for everyday clinicians. The purpose of this clinical commentary is to demonstrate the necessity of integrating COD movement assessments to screen for potential ACL injury risk, particularly among higher-risk populations. The authors will review cost-effective and clinic-friendly objective tests used to qualitatively screen COD movements, such as the Cutting Movement Assessment Score and The Expanded Cutting Alignment Tool. Additionally, this commentary will discuss key considerations when assessing COD movement.

Level of evidence: 5.

Context: Musculoskeletal disorders (MSKD) are currently the leading contributor to disability worldwide. Unlike other prevalent and disabling healthcare conditions such as CVD, risk factors associated with MSKD are not commonly discussed or integrated into current medical practice, rehabilitation practice or wellness programs. The primary purpose of this review is to describe the known risk factors most closely associated with MSKD. The secondary purpose is to propose a clinical model to manage MSK health aimed at maximizing the healthy pursuit of a physically active and healthy lifestyle.

Evidence acquisition: In this review the most common MSKD risk factors, with a focus on those that can be easily screened in clinical practice are presented. The importance of understanding the magnitude and number of risk factors present as well as the multidimensional nature of MSKD risk is discussed.

Results: A total of 11 MSKD risk factors were identified. Most of the risk factors are modifiable, and the evidence associated with modifiability for the most prominent risk factors is reviewed.Researchers have found that often patients are discharged from care with several known MSKD risk factors. In such instances, local pain and dysfunction are managed well, but expanding our rehabilitation care to include comprehensive risk factor management would ultimately benefit the patient and reduce healthcare costs.

Conclusion: The most common MSKD risk factors are discussed and a clinical framework to individualize intervention is proposed. Addressing key risk factors within rehabilitation may be an important step to reduce the enormous and growing burden these disorders are having on society.

Level of evidence: 5.

Background and purpose: The comprehensive treatment for an athlete who sustains a complete posterior cruciate ligament (PCL) injury remains unclear. The purpose of this case report is to describe the effects of an isokinetic exercise program on muscle performance and physical function in a professional soccer player with a PCL injury.

Study design: Case Report.

Case description: A 23-year-old male professional soccer player injured his right knee (non-dominant) during a soccer match, with magnetic resonance imaging confirming a complete PCL rupture. The athlete completed 23 sessions of isokinetic treatment over nine weeks to improve physical function and muscle performance. The concentric mode was used to evaluate quadriceps and hamstrings performance isokinetically at angular velocities of 60 °/s, 120 °/s, and 300 °/s. The LEFS questionnaire was used to evaluate physical function. The assessment occurred before starting the treatment and at the end of nine weeks. An athlete with similar anthropometric characteristics was invited to participate and serve as a control, in order to better understand the athlete's assessment results.

Outcomes: After nine weeks, peak torque normalized to body mass (PT/BM) improved to 4.0 N.m/kg for knee extensors (control: 3.6 Nm/kg) and 2.3 N.m/kg for knee flexors (control: 1.9 Nm/kg) at 60 °/s. This increase in PT was reflected in the hamstrings-to-quadriceps (H:Q) ratio post-treatment (57 %). At the end of treatment, the athlete returned to sports activities with 98.7 % restored physical function as measured by the LEFS (Score: 79 points).

Discussion: The results demonstrated that the isokinetic treatment improved knee functional capacity, with increased PT/BM for knee extensors and flexors and enhanced torque-holding capacity, indicating improved muscle performance.

Level of evidence: 5.

Background: After anterior cruciate ligament reconstruction (ACLR), asymmetry is likely to persist in single-leg (SL) vertical jump and drop jump performance than in SL hop distance. However, its relationship with the return to sport (RTS) remains unclear.

Hypothesis/purpose: This study aimed to determine the association between vertical jump performance after primary ACLR using hamstring tendon autograft and RTS at a pre-injury competitive level.

Study design: Cross-sectional study.

Methods: Patients who underwent primary ACLR using hamstring tendon autograft were recruited for this study. Participants who returned to pre-injury competition after ACLR were recruited at least eight months postoperatively. Knee condition was assessed, including joint laxity, range of motion, muscle strength, and knee pain intensity during sports activities. Performance variables were also assessed, including SL hop distance, jump height in SL vertical jump, and reactive strength index (RSI; jump height/contact time) in SL drop jump. Participants were asked to subjectively report whether they had returned to the same level of competition as pre-injury and their perceived sport performance intensity. Those who answered "Yes" to the dichotomous question and had a postoperative subjective athletic performance of > 80% were categorized into the Yes-RTS group. The primary outcome was the ability to achieve RTS at the preinjury level.

Results: Sixty-five patients (female, 35; male, 30) at 13.0 (13.0) [median (interquartile)] months after ACLR participated in this study. Thirty-nine (60%) were assigned to the Yes-RTS group. Regarding knee conditions, the No-RTS group had a significantly higher knee pain intensity, as assessed using a numerical rating scale (p<0.001, effect size -0.45). In the performance tests, the No-RTS group exhibited a significantly lower limb symmetry index of RSI during the SL drop jump compared to the Yes-RTS group (p=0.002, effect size 0.81).

Conclusion: Patients unable to achieve RTS after primary ACLR using hamstring grafts are more likely to exhibit asymmetric performance during the SL drop jump test, suggesting the significance of assessing jump symmetry when evaluating post-ACLR rehabilitation success.

Level of evidence: 3c.

Background: Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas.

Purpose: The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction.

Study design: Descriptive Cadaveric study.

Methods: The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal.

Results: A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior.

Conclusion: The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented.

Level of evidence: Level IV.