Journal of Sport Rehabilitation最新文献

Context: Detailed rehabilitation protocols after stem cell treatment are lacking. This case highlights the rehabilitation of a patient treated with human umbilical cord blood-derived mesenchymal stem cell implantation for a large osteochondritis dissecans lesion of the knee.

Case presentation: A 17-year-old male adolescent wrestler experienced persistent left knee pain for 1 year, unresponsive to 6 months of conservative treatment. MRI revealed a large osteochondritis dissecans lesion (38 × 18 mm) in the lateral femoral condyle, which was treated with human umbilical cord blood-derived mesenchymal stem cell implantation.

Management and outcomes: Rehabilitation was conducted in 4 phases. The protection phase (1-8 wk) emphasized weight-bearing restrictions, continuous passive motion, and early gait training. The gait recovery phase (9-12 wk) incorporated stationary cycling and open kinetic chain exercises. During the maturation phase (13-24 wk), maximal strength and proprioception exercises were introduced with antigravity treadmill running. The final recovery phase (24-52 wk) focused on plyometric drills and sport-specific activities. Team training resumed at 32 weeks, and return to full competitive training occurred at 52 weeks. The limb symmetry index for isokinetic knee-extensor strength and single-leg hop test reached 95.2% and 97.9%, respectively, by 12 months, indicating near-complete functional recovery. The modified MRI of cartilage repair tissue score improved from 40 to 60 points between 1 and 3 years postsurgery. Second-look arthroscopy revealed an International Cartilage Repair Society grade 1 at 35 months. International Knee Documentation Committee scores increased from 17.2 preoperatively to 98.9 at 2 years, while visual analog scale scores decreased from 10 to 2 over 3 years.

Conclusions: Accelerated weight bearing, early gait training, and phased strength exercises facilitated substantial improvements in function and cartilage healing in an adolescent wrestler with a large osteochondritis dissecans lesion. Further studies with larger cohorts are recommended to confirm these findings.

Purpose: Trunk function is not only related to physical fitness performance, but also important for the balance, and stability of the whole body. This study aimed to investigate the effects of 2 training methods on trunk stability and athletic performance in adolescent female basketball players.

Methods: Fifty-one healthy elite female basketball players (age: 14.76 [1.84] y, body mass index: 21.41 [1.96] kg/m2) were assigned to TRX training (n = 17), Swiss ball training (n = 17), or control groups (n = 17). Participants performed a progressive program of unstable core muscle training consisting of 8 different exercises, with each exercise performed in 3 sets, twice a week for 8 weeks. The outcome measures were a plank test, the modified double leg lowering task, and athletic performance including jumping, speed, agility, cardiopulmonary endurance, and the ankle proprioception.

Results: Significant group and time interaction were identified in the modified double leg lowering task (P = .032, η2 = .134), with post hoc comparisons revealing improvements in the TRX group (P = .014). The TRX group (8.6%) improved significantly more than the Swiss ball group (2.9%) when it comes to the modified double leg lowering average change percentage. The plank test also exhibited a significant group and time interaction (P = .033, partial η2 = .133), with notable improvements in both the Swiss ball (P = .001) and the TRX groups (P = .001). Athletic performance measures showed no significant differences among groups.

Conclusions: The results indicate that both TRX and Swiss ball training can increase core muscle strength and stability without compromising athletic performance after 8 weeks of training. Furthermore, incorporating core muscle training enhances power transmission capabilities. Nevertheless, considering the goal was to improve speed and ankle proprioception during preseason training, careful consideration must be given to the timing and intensity of any intervention involving unstable core muscle training.

Context: The baseball athlete incorporates the use of the entire kinetic chain while throwing. Hip range of motion (ROM) and strength have been previously studied in its relation to injury development. It is a clinical necessity to understand the normative profiles of hip musculoskeletal function across the playing career.

Objectives: To identify the normative hip ROM and strength profiles of baseball players across level of play.

Evidence acquisition: The researchers searched the electronic databases MEDLINE, SPORTDiscus, CINAHL, and Embase using a custom search strategy. After applying inclusion and exclusion criteria, 31 articles were reviewed. Of these 31 articles, 22 examined hip ROM and/or strength in uninjured baseball athletes. A manual search of the references of those 22 articles revealed 4 additional articles that met the inclusion criteria. In total, 26 articles were included in data collection.

Evidence synthesis: Articles were assessed for quality using the appraisal tool for cross-sectional studies. The appropriate hip ROM and strength data, along with player demographics, were extracted and reviewed to ensure accuracy. Articles were also categorized based on level of play and player position.

Conclusions: Hip ROM and strength profiles of baseball athletes across all levels of play were identified and presented to comprehensively summarize the available data on normative musculoskeletal hip profiles. Observed differences between positions and across levels of play were documented. In general, hip external rotation ROM was greater than internal rotation across all levels and between the stance and lead limbs. As age and level of play increased, the difference between hip external rotation and internal rotation ROM also increased. Hip strength increased as level of play (and subsequently age) increased. These summarized data can be used as benchmarks to compare clinical populations.

Context: With the rise in distance running, there is an increasing interest in reducing running-related injuries and improving performance. Foot strike patterns (FSP) and step rate (SR) are key factors in managing the external forces generated during foot contact in running. Adjusting SR may help alter FSP and improve running economy (RE), yet its effects on recreational runners are not fully understood. Thus, this study aimed to examine if SR manipulations are sufficient to shift FSP and whether the manipulations change the RE.

Design: Cross-sectional study.

Methods: Eighteen healthy recreational runners' (age: 30.2 [7.6] y) foot strike angle was calculated using 2D video motion analysis, and submaximal VO2 was measured while running on a treadmill during preferred and adjusted (±5% and ±10%) SR conditions. Foot strike angle was used to predict strike index and quantify FSP, and submaximal VO2 was analyzed to determine RE.

Results: Predicted strike index was significantly different between preferred SR and the -10% (P = .002), -5% (P = .002), and +10% (P < .001) SR conditions. Submaximal VO2 was significantly increased in the -10% (P < .001) and -5% (P = .002) SR conditions.

Conclusion: SR manipulations were sufficient to alter foot strike angle and predicted strike index in recreational runners, leading to moderate to significant changes in RE. These findings suggest that SR manipulation can be a useful tool for influencing FSPs and optimizing RE to enhance performance and reduce injury risk.

Context: Kinesiophobia is a substantial psychological factor that may impact sport performance and activities of daily living for individuals with chronic ankle instability (CAI). The purpose of this study was to determine the levels of kinesiophobia between collegiate athletes and nonathletes with and without CAI using quantitative and qualitative analyses.

Design: Cross-sectional survey.

Methods: A Qualtrics survey was distributed to college students. Ankle health status was evaluated using the Foot and Ankle Ability Measure Sport subscale, Identification of Functional Ankle Instability, and history questions. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11. A 4 × 2 analysis of variance was used to assess differences in athlete status (NCAA Division 1, intramural, club, and nonathlete) and ankle health status (CAI and healthy). An open-ended question was added to understand how kinesiophobia impacts individuals CAI. Data were analyzed via content analysis.

Results: Of the 531 respondents who completed the survey, 140 (116 = CAI and 24 = healthy) met the inclusion criteria for the study. There was a significant main effect for ankle health status for the Foot and Ankle Ability Measure Sport (CAI = 62.68 [15.11]%, healthy = 99.57 [0.01]%), Identification of Functional Ankle Instability (CAI = 21.63 [5.34], healthy = 2.42 [2.93]), and Tampa Scale of Kinesiophobia-11 (CAI = 26.04 [6.22], healthy = 16.75 [5.50]). There were no significant main effects for athlete status or interactions for any variables. Perceptual and behavioral responses were to major categories identified with the qualitative analysis. Fear, pain, and instability were higher order themes within perceptual responses. Activity avoidance and bracing were higher order themes within behavioral responses.

Conclusion: This study highlights the significant role of kinesiophobia in individuals with CAI, with those affected reporting higher levels of fear, pain, and instability compared with healthy individuals. Behavioral adaptations such as activity avoidance and bracing were common among qualitative responses. While no differences were observed across athlete statuses, these findings underscore the need for tailored interventions addressing both physical and psychological factors to improve outcomes for individuals with CAI.

The primary aims of this study were to determine acute and longitudinal relationships between static flexibility measures and running economy (RE). Seventy-one healthy recreational runners (34 males/37 females, age: 36.4 [12.4] y, body mass index: 23.3 [3.1] kg/m2) completed an aerobic fitness assessment (VO2max) based on self-selected half-marathon race pace (RP) and flexibility testing (standing toe-touch test and weight-bearing lunge test) at baseline and 2 to 3 weeks prior to an endurance running or multisport race (70 [21] d apart). Participants resumed self-selected training and physical activity between laboratory visits. Hierarchical linear regressions were used to assess relationships between flexibility and RE across timepoints, and pre-post changes in flexibility and RE. Interactions between age and flexibility, and experience and flexibility were also investigated. No significant differences (P > .05) were found between flexibility measurements and RE at RP from visit 1 to visit 2, nor were there any significant associations between RE at RP and scores on the weight-bearing lunge test or standing toe-touch test. However, there was a significant interaction between age and the weight-bearing lunge test on RE at RP (ß = -0.0270, P = .018) such that older runners with less flexibility and younger runners with greater flexibility were less economical at RP at baseline. Our findings suggest that reduced flexibility may decrease the energetic cost of running for older runners to a greater extent than it does for younger runners. When prescribing run training intensity and mileage, coaches and clinicians working with masters runners should be cognizant of the potential performance benefits of decreased ankle joint flexibility as well as the overall greater risk of calf injury in this population. Future research should consider the underlying mechanism by which age enhances the beneficial effects of decreased flexibility on RE.

Context: Subtalar dislocation is a rare but severe condition that usually requires emergency attention and could be associated with secondary injuries. Most of the research about this injury is case reports focused on the medical management, so there are no guidelines for rehabilitation and return to sport (RTS). This case report describes the rehabilitation and RTS in an amateur basketball player with an isolated medial subtalar dislocation on his right foot.

Case presentation: A 20-year-old amateur basketball player suffered a forced foot inversion after landing on an opponent's foot. The patient was taken to the emergency department for a closed reduction under anesthesia, followed by 2 weeks in a cast and 3 weeks in a walker boot.

Management and outcomes: Rehabilitation started after the immobilization period with the main objective of returning to the same level of competition. It was organized through a 4 phase continuum with a stepwise approach. After 16 weeks since injury, the patient returned to team training.

Conclusions: To our knowledge, this is the first report to inform on rehabilitation and RTS of medial subtalar dislocation. The 4 phases continuum model could be useful for clinicians for safe progression in this rare condition.

Context: Anterior cruciate ligament reconstruction (ACLR) is a known risk factor for knee osteoarthritis (OA). Since no disease-modifying treatments for OA exist, it is critical to understand joint responses to physical activity following an ACLR. Understanding knee cartilage deformation through ultrasound may provide a better understanding of how knee cartilage responds to running, and how this may contribute to OA pathophysiology and risk.

Objective: To compare medial femoral cartilage deformation, outcomes, and forces during running in females with and without a unilateral ACLR knee.

Design: Cross-sectional laboratory study.

Methods: Sixteen females (8 ACLR history, 8 controls) participated. ACLR participants had an average age of 20.75 (1.83) years, height of 165.07 (7.43) cm, mass of 65.97 (8.55) kg, and were 36.13 (18.74) months postsurgery; controls had an average age of 20.62 (1.84) years, height of 166.00 (5.76) cm, and mass of 63.18 (4.94) kg. Independent variables were group and limb, with dependent variables including patient reported outcomes Knee Injury and Osteoarthritis Outcome Score (KOOS), medial femoral cartilage thickness changes, and indirect measures of stance-averaged vertical ground reaction forces and vertical rate of loading normalized to body weight during treadmill running. Data were analyzed using nonparametric statistics with significance defined as P ≤ .05.

Results: All participants exhibited cartilage thickness reduction after 30 minutes of running (P < .001), with no significant group or limb differences in cartilage deformation, vertical ground reaction forces, or vertical rate of loading. ACLR participants reported significantly poorer patient reported outcome scores across all KOOS subscales. Moderate negative correlations were found between involved cartilage percent change and KOOS Symptoms (P = .025) and Sport/Rec (P = .043).

Conclusions: Cartilage thickness significantly decreased in all participants after running, with no group or limb differences observed despite lower patient-reported outcomes in the ACLR group. Exploring the relationship between KOOS scores and cartilage response to activity may inform future research and strategies to mitigate OA risk.

Neck pain ranks among the most prevalent musculoskeletal conditions and is commonly accompanied by altered physical function. With 10.8% of sports-related injuries affecting the head and neck, evaluating neck strength is vital for detecting muscle weakness and monitoring rehabilitation progress. The purpose of this study was to determine the intrasession and intersession reliability of a strain gauge for measuring neck retraction strength in healthy adult men. Ten male participants (age, 22.7 [2.6] y; body mass, 90.8 [13.3] kg; height, 184.2 [7.1] cm) completed a neck retraction isometric test across 3 testing occasions separated by 7 days. Contraction duration, peak and mean force, impulse, and peak rate of force development were quantified within and between sessions. Contraction duration, peak force, and impulse demonstrated moderate to excellent intra- (intraclass correlation coefficient [ICC] [3,1] = .72-.98, coefficient of variation [CV] = 2.7%-2.1%) and intersession reliability (ICC [3,k] = .66-.89, CV = 4.8%-7.1%); however, only acceptable intrasession reliability was found for peak rate of force development and mean force (ICC = .71-.99, CV = 3.4%-22.7%). It appears that a portable fixed strain gauge can be used to reliably measure neck retraction strength in a healthy male population.