International Journal of Sports Physical Therapy最新文献

Background: Augmentation of an arthroscopic Bankart repair with the remplissage (ABR) procedure has shown to confer a decrease in recurrence rates, yet, at the expense of potentially compromising shoulder motion.

Purpose/hypothesis: The purpose was to examine clinical studies that described a post-operative rehabilitation protocol after an arthroscopic Bankart repair and remplissage procedure. It was hypothesized that a review of the literature would find variability among the studies and that, among comparative studies, there would be a limited distinction from protocols for isolated Bankart repairs.

Study design: Systematic Review.

Materials and methods: A search was conducted using three databases (PubMed, EMBASE, and CINAHL) according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The following terms were combined while utilizing Boolean operators: (Bankart lesion OR labral tear) AND (remplissage). Studies evaluating patients after arthroscopic stabilization for unidirectional anterior glenohumeral instability with the addition of the remplissage procedure and at least 1 year follow-up were included for analysis.

Results: A total of 41 studies (14 Level IV, 24 Level III, 2 Level II, and 1 Level I) were included with a total of 1,307 patients who underwent ABR. All patients had <30% glenoid bone loss and a range of 10-50% humeral head size Hill-Sachs lesion. Type and position of immobilization were the most reported outcomes (41/41) followed by time of immobilization (40/41). Moreover, 23/41 studies described their initial post-operative shoulder range of motion restrictions, while 17/41 specified any shoulder motion allowed during this restrictive phase. Time to return to sport was also described in 37/41 of the retrieved studies. Finally, only two of the 27 comparative studies tailored their rehabilitation protocol according to the specific procedure performed, underscoring the lack of an individualized approach (i.e. same rehabilitation protocol for different procedures).

Conclusion: The results of the present systematic review expose the variability among rehabilitation protocols following ABR. This variability prompts consideration of the underlying factors influencing these disparities and underscores the need for future research to elucidate optimal rehabilitation. Based on the results of this systematic review and the senior authors´ clinical experience, a rehabilitation approach similar to an isolated Bankart repair appears warranted, with additional precautions being utilized regarding internal rotation range of motion and external rotation strengthening.

Level of evidence: Level 3.

Background: The Nordic hamstring exercise (NHE) is useful for preventing hamstring strain injuries. However, its adoption rates in the sports field are currently low, necessitating a safe and efficient introduction.

Hypothesis/purpose: The purpose was to examine the relationship between the eccentric force during the NHE and the one repetition maximum of deadlift. It was hypothesized that the eccentric force during the NHE would be correlated with the one repetition maximum (1RM) of the deadlift.

Study design: Cross-sectional study.

Methods: Healthy student rugby players with no history of hamstring tears were recruited to participate. The peak eccentric forces during the NHE, which is the vertical peak force on the part holding the leg, were measured in both legs, while gradually leaning forward to a prone position over three seconds. The 1RM of deadlift was calculated from the weight that could be raised three times during a deadlift (x kg) using the estimated formula (x kg / 0.93). The correlation between the left and right peak eccentric forces during the NHE, the total left and right forces, and the 1RM of the deadlift was examined using Spearman's rank correlation coefficient, with all values corrected for body mass.

Results: During the NHE, the peak eccentric force of the right and left legs and the total peak eccentric force of both legs were 3.8 ± 1.1 N/BM, 3.8 ± 1.2 N/BM, and 7.6 ± 2.1 N/BM, respectively. The 1RM of deadlift was 1.9 ± 0.3 kg/BM. Weak correlations (r = 0.34-0.37) were found between the 1RM of the deadlift and the peak eccentric force in the right and left legs and the total peak eccentric force of both legs.

Conclusion: The present study revealed a weak correlation between the peak eccentric force during the NHE and 1RM of deadlift.

Level of evidence: 2c.

Background: Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries.

Purpose: To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury.

Study design: Cross-sectional.

Methods: Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital.

Results: One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older.

Conclusion: The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics.

Level of evidence: 2b.

Background: Despite evidence of alarming declines in physical activity levels after anterior cruciate ligament reconstruction (ACLR), very little is known about how young athletes perceive their experiences with engagement in sports and physical activity in the years following ACLR.

Hypothesis/purpose: The purpose of this study was to answer the research question, "what are the lived experiences and perceptions of factors that facilitate or hinder physical activity among young athletes following ACLR?".

Study design: Qualitative Study.

Methods: Ten participants were included in this qualitative study at a median of 5.9 (4.3-10.2) years after adolescent ACLR. Using an interpretive phenomenological methodology, semi-structured interviews were conducted with each participant. Data collection focused on participants' lived experiences related to physical activity participation in the years after ACLR. Iterative coding with two independent coders and a peer debriefing process were used to identify themes from the data.

Results: Factors perceived to influence physical activity after ACLR spanned all levels of the socioecological framework. Three overarching themes were generated during thematic analysis: 1) navigation of barriers (common obstacles, injury-related limitations, unique adaptations), 2) movement motives (ingrained desire to move, external motivators, internal motivation), and 3) movement mindset (envisions for future physical activity, perceived impact of injury, belief in the power of sports).

Conclusion: The themes identified in this study indicate that the adolescent ACLR experience has the potential to significantly influence one's physical activity into young adulthood, both positively and negatively. These findings serve as an important foundation for future studies to explore the psychological and environmental factors identified as important to one's physical activity participation in the years following adolescent ACLR.

Level of evidence: Level 3.

Background: Unlike other sports, the relationship between performance deficits and pain/injury in lacrosse players has not been well-investigated.

Purpose: The purposes of this study were to: 1) determine whether age and sex differences exist in dynamic physical function tests and drop jump performance among lacrosse players, and 2) determine whether pre-seasonal physical function scores predict onset of either lower extremity or low back pain over time.

Study design: Prospective observational study.

Methods: Lacrosse players (N=128) were stratified into three groups: 12-14.9 yrs, 15-18 yrs and >18 yrs. Thomas test (hip flexibility), Ober's test (iliotibial band tightness), and Ely's test (rectus femoris tightness) were performed. Landing Error Scoring System (LESS) scores were collected while players performed drop jumps. Sagittal and frontal plane movement from 2D video during single and double legged squats was assessed. Musculoskeletal pain symptoms or injury were tracked for six months. Age bracket, sex and physical function scores were entered into logistic regression models to determine risk factors that predicted onset of lower extremity pain and low back pain onset.

Results: LESS scores and single-leg squat movement quality test scores were lowest in the 12-14.9 yr groups and highest in the >18 yr group (all p<0.05). Single leg squat performance score increased the odds risk (OR) for lower extremity pain (OR=2.62 [95% CI 1.06-6.48], p=.038) and LESS scores elevated risk for low back pain onset over six months (OR = 2.09 [95% CI 1.07- 4.06], p= .031).

Conclusions: LESS scores and single legged squat performance may help identify lacrosse players at risk for musculoskeletal pain or injury onset. Detecting these pertinent biomechanical errors and subsequently developing proper training programs could help prevent lower extremity and low back pain onset.

Level of evidence: III.

Background: Resistance training with the barbell back squat (BBS) exercise is practiced in sports, recreation, and rehabilitation. Although extensively debated, it is commonly believed and recommended that maintaining a neutral lumbopelvic alignment during BBS is an important technical aspect that might reduce the risk of injury. There is limited knowledge of how objectively measurable factors affect the extent to which the lumbopelvic region moves into flexion during a BBS.

Purpose: The aim of the study was to investigate the association among anthropometric measurements, range of motion in the hips and ankle joints, lumbopelvic movement control tests, and flexion of the lumbopelvic region during execution of the BBS.

Study design: Observational, cross sectional.

Methods: Eighteen experienced powerlifters and Olympic weightlifters were included and measurements of lumbopelvic movements were collected with inertial measurement units during BBS performed at 70 % of 1RM. Examination of anthropometric properties, range of motion in the hip and ankle joints, and lumbopelvic movement control tests were collected as independent variables. Linear regression analysis was used to investigate which independent variables were associated with lumbopelvic flexion during a BBS.

Results: The linear regression showed that a higher range of motion in ankle dorsiflexion could statistically significantly explain an increased amplitude of lumbopelvic flexion during the BBS. Anthropometrics, range of motion of the hips, and performance in lumbopelvic movement control tests did not show any statistically significant associations.

Conclusions: The results suggest that strength and conditioning professionals and clinicians who instruct and assess lifting technique in the BBS and/or use the BBS to assess performance or as an intervention should recognize that a higher range of motion in the ankle joints might affect lumbopelvic flexion during the BBS. In practice, the value of an individual assessment of lifting technique focusing on the goal of the movement should be emphasized.

Level of evidence: 3.

Background: A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury.

Hypothesis/purpose: This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores.

Study design: Cross-sectional study.

Methods: The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis.

Results: The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor.

Conclusion: The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles.

Level of evidence: 3B.

Rehabilitation protocols post-Achilles tendon repair vary widely, particularly regarding weight bearing (WB) and immobilization duration, impacting recovery trajectories significantly. This commentary focuses on rehabilitation strategies following acute Achilles tendon repair (ATR), emphasizing early mobilization and progressive loading. Techniques such as blood flow restriction training (BFRT) and progressive loading to restore strength and tendon mechanical properties are discussed in the context of optimizing recovery, minimizing tendon elongation and facilitating safe return to sport (RTS). This manuscript highlights current evidence and clinical insights to guide practitioners in optimizing rehabilitation protocols for athletes recovering from ATR, aiming to improve functional outcomes and support safe return to athletic activity.

Background: While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play.

Purpose: This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors.

Study design: Cross-sectional study.

Methods: Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e. pickleball T-test) were assessed.

Results: Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left r_s = -.41, p < 0.001, right r_s = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history.

Conclusion: Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward.

Level of evidence: 2.