Journal of Sport Rehabilitation最新文献

Context: Short daily surveys are common in elite sports to capture psychological outcomes, but there is no information on the surveys convergent validity and test-retest reliability. Therefore, the purpose of this study is to determine the validity and test-retest reliability of daily athlete health surveys in collegiate athletes.

Design: Descriptive study.

Methods: Participants (n = 193, 74 males and 119 females; age = 20.3 [1.4] y) responded daily to sliding scale questions regarding readiness (scored from 0 to 100), fatigue, stress, and sleep quality (-5 [indicating low or poor scores] to +5 [indicating high or "good" scores]). At pre- and midseason times, participants completed the Perceived Stress Scale, Pittsburgh Sleep Quality Index, Athlete Sleep Screening Questionnaire, Overuse Injury Scale, and the Acute Recovery and Stress Scale. To assess validity, Spearman rho (ρ) correlation coefficients were used to assess the relationship between each athlete health variable and the corresponding validated survey. Reliability and precision were assessed with the intraclass correlation coefficient and the standard error of measurement, respectively.

Results: Daily stress was correlated with the Perceived Stress Scale (ρ = -.40, P < .001); daily sleep quality was associated with the Pittsburgh Sleep Quality Index (ρ = -.44, P < .001) and the Athlete Sleep Screening Questionnaire (ρ = -0.46, P < .001), and daily readiness was associated with the Overuse Injury Scale (ρ = -.21, P = .003). Daily fatigue was associated with the recovery (ρ = .37, P < .001) and stress dimensions (ρ = -.36, P < .001) of the Acute Recovery and Stress Scale. All daily athlete health variables demonstrated either good or excellent reliability (intraclass correlation coefficient = .85-.94; standard error of measurement = 0.87-4.94).

Conclusions: All daily health variables demonstrated acceptable reliability and precision. Sleep quality and stress were most strongly correlated with the outcome scores of their validated surveys. Fatigue was related to the Acute Recovery and Stress Scale, and readiness demonstrated a weak correlation to the Overuse Injury Scale. Clinicians should feel comfortable using these single-question daily health surveys in clinical care but exert caution when using readiness, and fatigue.

Adolescent athletes participating in sports involving sudden directional changes, pivoting, and jumping frequently sustain anterior cruciate ligament (ACL) ruptures. ACL reconstruction (ACLR) surgery is often required, followed by a lengthy rehabilitation period. This study aims to evaluate the effectiveness of combining BOth Sides Up (BOSU) ball exercises with conventional resistance training in the recovery of joint stability and function after ACLR in adolescent athletes. Thirty adolescent athletes (ages 14-18) who underwent ACLR were randomly allocated to either the control group receiving traditional postoperative rehabilitation (n = 15) or the intervention group combining BOSU ball training with resistance exercises (n = 15). Joint stability, proprioception, strength, and functional outcomes were assessed before the procedure, as well as 3, 6, and 12 months after the operation using the KT-1000 arthrometer, Y-balance test, isokinetic dynamometry, and the ACL-Return to Sport after Injury ACL-Return to Sport after Injury (ACL-RSI) scale. The intervention group demonstrated notably better anterior-posterior knee joint stability (P < .05) than the control group at the 6-month and 12-month follow-ups after the surgery, greater reach distances in the Star Excursion Balance Test (P < .05), higher quadriceps and hamstring strength ratios (P < .05), and superior ACL-RSI scores (P < .01). Incorporating BOSU ball training with resistance exercises appears to be more effective than traditional rehabilitation alone in enhancing joint stability and neuromuscular control after ACLR in adolescent athletes. These results provide evidence supporting the incorporation of unstable surfaces into a comprehensive rehabilitation program to optimize recovery and safe return to sports.

Context: Many healthcare professions incorporate foam rolling (FR) and static stretching (SS) to improve tissue extensibility. Currently, it is unknown if the order an individual performs FR and SS influences flexibility or whether flexibility is retained. This study aimed to determine if FR before, or, following SS influences passive hip flexion range of motion (ROM), and if changes are retained.

Design: Between-group experimental design.

Methods: Thirty-five participants with less than 90° of passive hip flexion ROM volunteered. Over 8 days, 6 days separated by 24 hours, and then 1 week (day 7) and 2 weeks (day 8) following the last treatment, ROM was measured before and following 1 of 5 treatments; FR/SS, SS/FR, SS, FR, or nothing (control). Participants laid supine on a table where a bubble inclinometer was placed on the tibia of the dominant leg with the hip passively flexed to establish pretreatment ROM. Participants then received the treatments. Passive hip flexion ROM was assessed from pretreatment on day 1 to posttreatment on day 6, day 7 (1 wk), and day 8 (2 wk).

Results: Passive hip flexion ROM increased for those receiving FR/SS, SS/FR, FR, and SS. ROM with FR and SS/FR was retained at day 7 but not day 8. Hip flexion ROM for FR/SS and SS were not retained at day 7 nor 8. SS/FR resulted in greater ROM than FR on day 6. SS/FR, FR/SS, SS, and FR were greater than the control at day 6. SS/FR was also greater than the control on days 7 and 8.

Conclusion: This study revealed that FR the hamstring muscles after SS produces the greatest gains in passive hip flexion and would be appropriate in noninjured patients with less than 90°.

Introduction: Running overuse injuries are among the most common running-related musculoskeletal injuries. Modifying gait has been recognized as an effective strategy for preventing running overuse injuries. This study investigates whether gentle heel strike (GHS) running decreases the impact loading rate during 30-minute runs in healthy participants.

Methods: In this prospective cohort interventional study, 20 male participants underwent gait modification in a controlled laboratory setting, with the goal of reducing heel impact through real-time visual feedback. Comprehensive measurements, including plantar contact, force, pressure, and detailed kinetic and kinematic analyses, were employed to assess changes in gait dynamics.

Results: GHS significantly shifted plantar pressure, reducing heel forces and increasing forefoot load. Mean heel force decreased by 0.32 (0.1) body weight (BW) and heel pressure reduced by 0.1 kPa/BW. Although peak vertical ground reaction force and anterior-posterior ground reaction force did not change significantly across the entire stance phase, early stance vertical ground reaction force (7%-12% of the gait cycle) was reduced, leading to the disappearance of the vertical impact peak. Vertical impact peak dropped from 1.45 (0.23) to 1.27 (0.25) BW. Significant reductions were also seen in the vertical instantaneous loading rate, which decreased from 68.32 (14.20) to 46.77 (13.95) BW/s, and the vertical average loading rate, which fell from 54.96 (14.38) to 38.84 (12.62) BW/s (P < .001).

Discussion: GHS has the potential to modify running mechanics by redistributing plantar pressure and diminishing heel impact force. This reduction in heel impact force could lead to a change in landing pattern anteriorly and a decrease in loading rates, potentially reducing the risk of running overuse injuries.

Conclusion: Visual biofeedback-guided GHS is feasible in healthy participants, and it effectively reduces the loading rate during running for 30 minutes.

Context: In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP.

Design: Randomized single-blind clinical trial.

Methods: Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention.

Results: At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001).

Conclusion: It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Context: Epidemiological studies have shown an increased risk of musculoskeletal injury after concussion. The purpose of this study was to determine whether the reverse relationship exists, specifically whether there is an increased risk of concussion after an anterior cruciate ligament (ACL) injury in a population-based cohort.

Design: Retrospective cohort.

Methods: The Rochester Epidemiology Project was searched between 2000 and 2017 for International Classification of Diseases, 9th and 10th Revision codes relevant to the diagnosis and treatment of concussion and ACL tear. A total of 1294 unique patients with acute, isolated ACL tears and no previous history of concussion were identified. Medical records for cases were reviewed to confirm ACL tear diagnosis and to determine history of concussion after the ACL injury. Cases were matched by age, sex, and Rochester Epidemiology Project availability to patients without an ACL tear (1:3 match), resulting in 3882 controls. Medical records of matched control patients were reviewed to rule out history of ACL injury. The hazard ratio of concussion injury following an ACL injury was determined.

Results: Nine patients with an ACL injury suffered concussion up to 3 years after the ACL injury. The rate of concussion was no different between ACL-injured cases (0.7%) compared with matched controls with no ACL injury (1.2%), which corresponded to a hazard ratio of 0.55 (95% confidence interval, 0.3-1.1; P = .10).

Conclusions: Based on the current evidence, there does not appear to be a significant association between ACL injury and subsequent concussion, which suggests that a concussion uniquely affects the risk of future subsequent musculoskeletal injury.

Purpose: The effectiveness of neuromuscular electrical stimulation hinges on the evoked torque level, which can be attained through either conventional (CONV) or wide-pulse high frequency (WPHF). However, the best electrode placement is still unclear. This study adopted a crossover design to compare the effects of WPHF applied to the tibial nerve trunk (N-WPHF) or muscle (M-WPHF) with CONV in healthy participants.

Methods: A total of 30 participants (age: 22.4 [4.5]) were involved in 4 sessions. During each session, participants performed: 2 maximal voluntary contractions, 2 contractions at maximal evoked torque, and 2 contractions at submaximal evoked torque at 20% maximal voluntary contraction. Neuromuscular electrical stimulation intensity-evoked torque, efficiency, and discomfort were measured in maximal and submaximal conditions. Statistical analyses were conducted using a 1-way mixed-model analysis of variance with repeated measures.

Results: N-WPHF and M-WPHF showed higher evoked torque than CONV (P = .002 and P = .036) and greater efficiency than CONV for maximal evoked torque (P = .006 and P = .002). N-WPHF induced higher efficiency than M-WPHF and CONV for submaximal evoked torque (P = .004). Higher discomfort was observed for both N-WPHF and M-WPHF for submaximal evoked torque compared with CONV (P = .003 and P < .001).

Conclusion: Our results suggest that WPHF applied at either the nerve or muscle could be the best choice for the maximal condition, whereas nerve application is preferred for the submaximal condition.

Context: Shoulder impingement syndrome (SIS) is the most common shoulder injury among overhead athletes. The Constant score (CS) is a combined scoring system to evaluate functional status of the shoulder in patients with shoulder pain.

Design: Cross-sectional study.

Methods: Cultural adaptation of the Persian version of CS was conducted using Beaton's guideline. Sixty-three overhead athletes (23.57 [7.50] y old) with SIS completed the final version for psychometric assessment. After 5 to 7 days, a group of 33 patients completed the Persian CS again to assess test-retest reliability. Internal consistency, floor/ceiling effects, and item-total correlation were evaluated in patients with SIS. Concurrent validity was assessed through comparison with the disability of the arm, shoulder, and hand questionnaire scores. Twenty-five healthy athletes (31.80 [7.32] y old) participated for determining discriminant validity.

Results: The Persian CS demonstrated good test-retest reliability, with subjective and objective intraclass correlation coefficients of .79 and .80, respectively. The internal consistency was satisfactory (Cronbach alpha = .74). No ceiling or floor effects were noted. The Pearson correlation coefficient between CS and disability questionnaire was -.68. The mean total score for patients was 67.02, while for the healthy group was 96.99 (P = .000). The standard error of measurement was 1.51 for patients and 0.7 for healthy group. The smallest detectable change was 16.95 for patients and 5.71 for healthy group.

Conclusion: The translation and cross-cultural adaptation of CS into Persian were successful. The Persian version demonstrates sufficient reliability and validity to evaluate shoulder function in overhead athletes with SIS.

Context: This study aims to provide data on the reliability and validity of an adapted Spanish version of the Athlete Psychological Strain Questionnaire (APSQ) when administered to Spanish athletes.

Design: A cross-sectional study was developed.

Methods: Data were collected from 128 athletes (males n = 71; females n = 57). The tools used in this study were the APSQ; Kessler Psychological Distress Scale; and Depression, Anxiety, and Stress Scales. The intraclass correlation coefficient was used to determine relative reliability, whereas standard error measurement and minimal detectable change were used to evaluate absolute reliability. Bland-Altman plots were employed to assess test-retest agreement and potential systematic bias.

Results: Data indicate that the Spanish version of the APSQ demonstrated satisfactory internal consistency (α: .77-.85) and generally fair to good test-retest reliability (intraclass correlation coefficient: .702; 95% CI, .602-.780). Significant associations were found between the APSQ Spanish version and the Depression, Anxiety, and Stress Scales (ρ = .64-.82), with fair to good agreement, whereas fair to moderate levels of agreement were established between the APSQ Spanish version and the Kessler Psychological Distress Scale (ρ = .53-.75).

Conclusions: These results provide preliminary evidence supporting the use of the APSQ Spanish version for mental health screening among Spanish athletes. However, the lack of absolute reliability raises concerns about its utility for assessing the effects of interventions aimed at improving mental well-being.

Clinical scenario: Shoulder pain is the third most common musculoskeletal complaint. The most common type of shoulder pain is subacromial impingement syndrome (SIS). The concept of regional interdependence demonstrates that body regions are interrelated, affecting how they function. Previous studies have reported the influence of the thoracic spine on the shoulder.

Clinical question: Does adding thoracic spine manipulation or mobilization to exercise in adults with SIS improve shoulder range of motion (ROM), pain, and disability?

Summary of key findings: The literature was searched for level 2 evidence or higher that examined the effects of the addition of thoracic mobilization or manipulation to exercises in shoulder ROM, pain, and disability in SIS. Twenty articles related to the clinical question, but only 3 met the inclusion and exclusion criteria. Two studies reported that the combination of thoracic mobilization or manipulation and exercises resulted in more significant improvements in shoulder ROM, pain, and disability compared to exercises alone. One study concluded that the combination of thoracic or shoulder mobilization to exercises was superior to ultrasound or exercises alone.

Clinical bottom line: There is moderate evidence to support the addition of thoracic manipulation or mobilization to exercise in treating SIS to improve shoulder ROM, pain, and disability.

Strength of recommendation: Grade B evidence supports a multimodal approach using the combination of thoracic mobilization or manipulation and exercises in adults with SIS.