International Journal of Sports Physical Therapy最新文献

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.

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.