Journal of Sport Rehabilitation最新文献

Clinical scenario: Anterior cruciate ligament (ACL) injuries are a common injury experienced by athletes and often involve lengthy and invasive treatments. Given the literature that exists supporting psychosocial response to injury, it is important to understand how these factors influence the recovery process ultimately influencing readiness to return to play.

Clinical question: What is the impact of psychosocial factors on athlete readiness to return to sport participation post-ACL reconstruction (ACLR)?

Summary of key findings: All studies found that psychosocial factors, including athletic identity, motivation, anxiety, control, and fear, impacted perceived readiness to return to play. Several studies found various levels of influence in both a positive (eg, motivation and resilience) and negative (eg, fear and anxiety) direction. Furthermore, despite presenting more psychosocial barriers than physical, these factors do not appear to influence actual physical recovery.

Clinical bottom line: Psychosocial factors have both direct and indirect effects, positive and negative, on an athlete's perceived readiness to return to the play. ACLR rehabilitation protocols are well developed, well established, and known to be effective; however, athletes still do not feel ready to return, and there are physical and mental risks associated with that uncertainty. Therefore, psychosocial factors are important to include and prioritize as part of the ACLR recovery process to ensure athletes are physically and psychosocially ready to return to play.

Strength of recommendation: Grade B evidence exists that psychosocial factors positively and negatively impact physical recovery and perceptions of recovery on return-to-play post-ACLR.

Context: Medial tibial stress syndrome (MTSS) is a common chronic injury of the lower-extremity in the physically active population. However, the risk factors for MTSS remain unclear.

Objective: This study identified the risk factors for MTSS and established the continuum model of lower-extremity alignments, range of motion, muscular strength, and gait kinematics affecting each other and MTSS development.

Evidence acquisition: Online databases including PubMed, CINAHL, SPORTDiscus, and Web of Science were used to retrieve studies related to risk factors for MTSS. The study eligibility criteria were studies that used the MTSS definition of the Yates and White criteria, or included participants with MTSS, except for stress fracture and compartment syndrome. A total of 2099 papers were retrieved during the initial search stage. After screening, based on eligibility criteria and cross-reference, 21 papers were included in this study. Data on lower-extremity alignments, range of motion, muscular strength, and gait biomechanics were extracted as outcome variables for this meta-analysis. Publication bias was assessed using funnel plots and Egger's regression analysis.

Evidence synthesis: Foot posture index (standardized mean difference [SMD] = 1.23; 95% CI, 0.02-2.43), intercondylar interval (SMD = 0.29; 95% CI, 0.10-0.48), inversion range of motion (SMD = 0.37; 95% CI, 0.10-0.63), eversion strength (SMD = 0.37; 95% CI, 0.10-0.65), and dynamic arch height change during walking (SMD = 1.05; 95% CI, 0.49-1.60) were significant risk factors for MTSS. Egger's regression analysis revealed asymmetry in several variables, which indicates publication bias. The trim-and-fill method was applied to these variables. A comparison between the SMD and adjusted SMD showed that the variables had minimal impacts on the meta-analysis.

Conclusions: Based on our results, health care professionals should assess the significant risk factors in patients before participation in physical activities and treat them to prevent and rehabilitate MTSS.

Context: Professional soccer players frequently experience fatigue due to the demanding nature of the sport. In this context, effective recovery strategies are essential for maintaining performance. Static stretching (SS) is commonly used in soccer, but its efficacy is debated. Vibration foam rolling (VFR) is a novel recovery technique that has not been extensively studied in soccer.

Objective: This research aimed to investigate the acute effects of VFR (3 sets of 45 s of rolling and 15 s of rest between sets) and SS (3 sets of 45 s and 15 s of rest between sets) on muscle contractile properties in professional soccer players.

Design: Eighteen players participated in this counterbalanced crossover study. Settings: After a 1-week washout period between sessions, the subjects completed the 2 condition trials (VFR or SS) in counterbalanced order following a training session, which had a duration of 77 min and a total distance of 6500 m covered.

Main outcome measures: Muscle contractile properties of the rectus femoris were assessed with tensiomyography before training (pre), immediately after training (post 1), and postrecovery intervention (post 2). Tensiomyography parameters included maximal radial muscle-belly displacement and contraction time and velocity. Data were analyzed using repeated-measures analysis of variance.

Results: There were no significant differences in the training load between groups during the training sessions (P > .05). Results showed that maximal radial muscle-belly displacement (P = .004) and contractiontime (P = .007) significantly decrease from pre (before training) to post 1 (after training). No significant main effects for group were obtained for all the variables (P > .05). However, both VFR and SS interventions effectively restored maximal radialmuscle-belly displacement (P = .011) and contraction time (P = .008) from post 1 (after) to post 2 (postrecovery intervention), suggesting reduced muscular stiffness. Contraction velocity remained unchanged after both interventions (P > .05).

Conclusions: Therefore, these interventions could offer valuable advantages for posttraining neuromuscular acute recovery in professional soccer players.

Context: The rate of force development (RFD), defined as the ability to rapidly generate muscle force, is commonly tested using an electromechanical dynamometer in isometric mode. However, these devices are expensive and not readily available. Therefore, this study aims to evaluate the interrater reliability of a fixed handheld dynamometer to measure the knee extensors' RFD and provide reference values using the proposed method.

Design: This study used a cross-sectional study design.

Methods: Using a fixed handheld dynamometer (microFET2) and a 3-dimensional-printed adapter, we evaluated the knee extensor muscles  in participants seated at the edge of a treatment bed. Each participant performed a standardized warm-up, followed by 3 maximal isometric knee extension trials. The outcome measures were peak force and early and late phase RFD (0-100 and 0-200 ms, respectively). The study consisted of 3 sessions: Visit one comprised of an initial session (session 1A) followed by a second session (session 1B) after 30 minutes for intrasession reliability; and visit two, conducted on week later, comprised the third session (session 2) for intersession reliability.

Results: Fifty-one participants were enrolled in the study. The in-session intraclass correlation coefficient for the early phase RFD was .87 (95% CI, .74-.92) and .91 to .92 (95% CI, .87-.94) for the late phase. The between-session intraclass correlation coefficient for the early phase RFD was .83 to .86 (95% CI, .74-.91) and .87 to .90 (95% CI, .80-.94) for the late phase. Finally, the peak force's intraclass correlation coefficient was .95 (95% CI, .92-.97) for the in-session and .91 to .92 (95% CI, .86-.95) for the between-session reliability.

Conclusions: Our approach provides a reliable, cost-effective, and quick method to evaluate the knee extensor muscles' RFD and peak force.

Context: Plantar fasciopathy (PF) is a common, self-limiting condition with notable economic impact and multifactorial origins. Clinical tests help clinicians to identify specific dysfunction and limitations influencing PF's clinical course. This study aims to investigate whether body mass index (BMI) influences the performance of clinical tests and clinical presentation of individuals with PF and to determine whether BMI and clinical tests predict the clinical course of PF over a 3-month follow-up period.

Design: This study is a longitudinal observational study. Participants were grouped, according to the median BMI, into low and high BMI.

Setting: Healthcare centers and physiotherapy clinics.

Participants: Fifty-two individuals with PF participated in this study.

Main outcome measures: Baseline: Ankle dorsiflexion range of motion and navicular drop, heel-rise, and step-down tests were administered. Pain intensity and function were measured at baseline and at 3-month follow-up.

Results: Low BMI group showed better function (mean difference = 11.8; 95% CI, 1.9 to 21.6) and lower pain intensity (mean difference = -1.5; 95% CI, -2.6 to -0.3) than the high BMI group. In the multivariable regression model, higher BMI predicted lower function (beta coefficient = -1.20; 95% CI, -2.3 to -0.3).

Conclusions: In individuals with PF, BMI levels influenced PF clinical presentation. The high BMI group showed more severe pain and lower function. Higher BMI was found to be a poor prognostic factor for function in individuals with PF.

Context: Sport-related concussion management often requires referral to physical therapy (PT).

Objectives: To (1) outline the role of PT in the management of sport-related concussion, (2) describe patients who underwent PT, and (3) discuss outcomes of athletes who underwent PT.

Design: Retrospective cohort study.

Setting: Single institution.

Methods: Adolescent athletes aged 14-19 years old who sustained a sport-related concussion from November 2017 to April 2022 were evaluated. The cohort was dichotomized into 2 groups: PT versus no PT. The outcomes were days from initial PT visit to symptom resolution (SR) and return-to-play. Subgroup analyses compared recovery metrics between those initiating PT before and after 30 (1 mo) and 90 days (3 mo) of injury. A univariable and multivariable regression was used to determine predictors of recovery.

Results: Of 1010 concussed athletes, 205 (20.3%) received referral for rehabilitation, and 58 (28.3%) patients received PT at the parent institution. Those who received PT had a higher number of prior concussions compared with those who did not (PT: 1.0 [1.2]; non-PT: 0.6 + 1.0; χ2 = 19.37, P = .007). A large proportion of PT recipients reported headache (n = 45, 81.0%); visual disturbances (n = 32, 65.5%); and vestibular (n = 37, 63.8%), cervical (n = 25, 43.1%), or oculomotor dysfunction (n = 25, 43.1%). Most patients received exertional therapy (n = 32, 55.1%), vestibular therapy (n = 31, 53.4%), and/or cervical therapy (n = 30, 51.7%). Those initiating PT before 1 and 3 months had significantly shorter median times to SR compared with those initiating after 1 and 3 months, respectively. Multivariable regression showed that a shorter time between injury and the initial PT visit was predictive of faster SR (β = 1.66, P = .048).

Conclusions: Headache, dizziness, and visual disturbances were commonly reported symptoms by patients who received PT. Cervical, vestibular, and oculomotor deficits were common objective findings by physical therapists, and cervical, vestibular, and exertional therapy were common interventions. Delayed time to PT was independently associated with a longer time to SR.

Purpose: Poor posture has a negative impact on physical capability and is associated with changes in biomechanics and motor control. The purpose of this study was to assess the effect of corrective exercises on ground reaction forces (GRFs) in male student handball players with upper crossed syndrome (UCS) during throwing.

Methods: Thirty male handball students with UCS participated in this single-blind randomized controlled trial (IRCT20200622047888N2; IR.HUMS.REC.1402.135). Fifteen received an 8-week corrective exercise intervention (exercise-intervention group [EG]), consisting of exercise targeting muscles involved in the UCS, and 15 served as the control group (CG). During handball throwing, GRF was measured by force plate. The forward head and rounded shoulder angles were measured with a photogrammetric method. All measurements were repeated 8 weeks later.

Results: Significant interactions for virtually all parameters indicated that changes over 8 weeks differed between the CG and EG. A reduction in GRFs and a delayed occurrence of peak GRFs were observed in the EG, but not in the CG (P < .05). This was accompanied by a significant reduction in forward head (P < .03; effect size: 0.87; 95% confidence interval, -2.34 to 0.13), rounded shoulder (P < .05; effect size: 0.68; 95% confidence interval, 0.32 to 1.22) and thoracic kyphosis (P < .02; effect size: 0.64; 95% confidence interval, 0.54 to 1.25) angles in the EG (P < .05) with no significant change over 8 weeks in the CG.

Conclusion: Corrective exercises targeting muscles directly involved in UCS induces functional and postural improvements in male student handball players with UCS.

Context: Clinical balance assessments vary in reliability due to subjectivity in their scoring. A valid and objective accelerometer-based smartphone evaluation could benefit patients, clinicians, and researchers.

Objective: Our objective was to assess the validity and reliability of smartphone-based standing balance.

Design: A repeated-measures study was conducted with 23 healthy young adult participants across 2 sessions ∼7 days apart.

Methods: Participants completed 30-second standing trials during tandem-stance eyes-open, tandem-stance eyes-closed, single-leg eyes-open, and single-leg eyes-closed conditions. Android and iOS smartphones were placed vertically on the lower back via a belt with 3 retroreflective markers attached and tracked by an 8-camera motion capture system. Sway path, range, and area were calculated from smartphone accelerometer and marker data. We assessed reliability using intraclass correlation coefficients (ICC[2,k]) and validity using Pearson r correlations between the marker and smartphones from visit 1.

Results: Across eyes-open conditions, Android (ICC = .84-.96), iOS (ICC = .82-.98), and marker-based (ICC = .84-.95) assessments demonstrated good to excellent reliability. Across eyes-closed conditions, Android (ICC = .41-.87), iOS (ICC = .34-.79), and marker-based (ICC = .31-.87) assessments demonstrated poor to good reliability. Correlations between smartphones and the marker data were moderate to very high (r = .56-.97).

Conclusions: The smartphone-based assessment was valid and reliable, indicating that clinicians and researchers can implement this method to measure balance with the opportunity for remote administration and increased patient tracking across various recovery timepoints.

Context: Variables associated with pain catastrophizing and beliefs in athletes presenting with musculoskeletal pain and/or sports-related injuries are largely unexplored.

Objective: We aimed to evaluate which anthropometric, sociodemographic, sporting, injury history, and care-seeking characteristics were associated with the Pain Catastrophizing Scale (PCS) and Pain Beliefs and Perceptions Inventory (PBAPI) scores in athletes.

Design: This study followed a cross-sectional design.

Methods: Three hundred and twelve athletes (40% females) from different sports and levels completed a questionnaire including demographic information, details regarding sports practice, injury history, health care use, PCS, and PBAPI. Univariable associations between PCS and PBAPI scores and each variable were assessed using linear regression. Variables with univariable associations where P < .05 were entered into multivariable regression models.

Results: The final multivariable model including gender, recurrent and persistent pain, a history of a severe atraumatic injury, and a history of more than 5 atraumatic injuries explained 14.9% of the variance in PBAPI scores. Performing a team sport and a history of more than 5 atraumatic injuries explained 5.1% of the variance in PCS scores.

Conclusions: Gender, sporting, and injury history characteristics explained only a small portion of the variance in PCS and PBAPI scores, whereas having received healthcare support and the number of appointments did not. Most of the variance was left unexplained.

Context: Femoroacetabular impingement syndrome (FAIS) is a movement-related condition associated with pain and impaired function; yet the evidence for level ground walking hip biomechanics is limited and inconsistent. Challenging the hip with inclined walking for individuals with FAIS might be important for elucidating mechanically driven function loss and informing tailored rehabilitation. The purpose of this study was to determine the effects of progressive inclined walking on sagittal hip biomechanics and hip flexor and extensor activity in individuals with FAIS.

Design: Cross-sectional.

Methods: Fourteen participants (7 individuals with FAIS and 7 asymptomatic individuals) underwent motion capture and electromyographic analysis during 3 treadmill walking conditions (0°/5°/10°). Statistical parametric mapping was used to compare the sagittal hip kinematic waveforms and hip flexor (rectus femoris) and extensor (gluteus maximus) waveforms between groups and walking conditions.

Results: Hip flexion was significantly increased throughout the gait cycle in individuals with FAIS compared with asymptomatic individuals (P < .01) but was not dependent on incline. Rectus femoris activation was significantly increased throughout stance in individuals with FAIS compared with asymptomatic individuals (P < .01). Gluteus maximus activity significantly increased with progressive inclination in asymptomatic individuals (P < .01), with no significant change in activity for individuals with FAIS.

Conclusions: Hip biomechanics and muscle activity during inclined walking mirrored that of arthrogenic muscle inhibition, highlighted by a prominent flexor role and lack of hip extensor activity in individuals with FAIS. Future research investigating discordant activity between hip flexors and extensors during complex functional tasks may help identify rehabilitation targets.