Journal of Sport Rehabilitation最新文献

Context: Field hockey is a popular sport in Australia and worldwide. However, there is limited evidence investigating the most frequent injuries and mechanisms of injury in Australia. We aimed to identify the location and characteristics of injuries of field hockey players in Australia in the 2023 winter season.

Design: Cross-sectional.

Methods: We sought to recruit field hockey players aged ≥14 years in Australia who played the winter season in 2023. We used a self-report survey to collect information about demographics, participation and facilities access, previous injury history, and injuries sustained during a season.

Results: We included 1474 (906 [61.6%] female) players including all states and territories of Australia. Juniors (≤18 y) were the most common competition group to complete a warm-up (92.5%) or structured injury prevention program (25.2%). Previous anterior cruciate ligaments ruptures were reported by 7.6% of participants and previous major and minor concussions were reported by 12.5% and 34.4% of participants, respectively. Over half of participants (52.8%) reported at least 1 injury during the 2023 winter season. The knee was the most common injured body part (14.4%) and overuse/insidious onset was the most common injury mechanism (19.5%). Head and face injuries were reported by 10.2% of participants, including 6% concussions.

Conclusions: We have reported the location and characteristics of frequent hockey injuries in Australia during the 2023 winter season. Priority areas for injury prevention include increasing participation in warm-up and injury prevention activities and protecting the head and face due to the risk of concussion.

Context: Neuromuscular training (NMT) enhances balance among recreational athletes, but the effectiveness of single- versus multicomponent NMT remains unclear.

Objective: To compare the effectiveness of single- and multicomponent NMT on balance performance among recreational athletes and explore the influence of age, injury status, athletic demands, and frequency/length of training.

Evidence acquisition: Five databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, SPORTDiscus, and Web of Science) from inception to October 2024 for randomized controlled trials comparing single- versus multicomponent NMT with non-NMT controls. Random effects meta-analysis and network meta-analysis were conducted.

Evidence synthesis: Seventeen studies (n = 716 participants) were included. No significant differences in overall balance performance were found between single (standard mean difference [SMD]single: 0.15; 95% CI, -0.05 to 0.34) and multicomponent NMT (SMDmulti: 0.20; 95% CI, -0.01 to 0.41). Similar trends were observed in subgroup analysis: static (SMDsingle: 0.15; 95% CI, -0.10 to 0.40 vs SMDmulti: 0.08; 95% CI, -0.17 to 0.34) and dynamic balance test (SMDsingle: 0.30; 95% CI, -0.14 to 0.75 vs SMDmulti: 0.40; 95% CI, -0.09 to 0.88). Sensitivity analysis indicated multicomponent NMT significantly benefited injured adults (SMDmulti: 0.06; 95% CI, 0.02 to 0.09) and younger adults under 50 years (SMDmulti: 0.05; 95% CI, 0.03 to 0.08).

Conclusions: While no overall difference was found between single- and multicomponent NMT, age and injury status influenced the outcomes. Tailored NMT protocols may optimize balance and prevent injuries in recreational athletes. PROSPERO (CRD42023391531).

Context: ForceFrame values for hip adduction, abduction, and adduction:abduction strength ratio do not currently exist in the literature for female soccer players. Such values are needed and would inform both strengthening programs and rehabilitative exercise prescription. The purpose of this study was to compare hip adduction and abduction force outputs and hip adduction:abduction ratios across common testing positions in healthy elite-level female soccer players.

Design: Cross-sectional cohort study.

Methods: Isometric hip adduction and abduction force outputs and ratios were obtained from 32 female soccer players, using a ForceFrame, in the 0° hip-flexion long-lever position, 0° hip-flexion short-lever position, and 45° hip-flexion position. A 1-way repeated-measures analysis of variance was used to examine differences in force output between testing positions. Statistical significance was accepted as P ≤ .05.

Results: Analysis of variance revealed no significant differences in hip adduction force output between the 45° hip-flexion position (266.4 [55.77] N) and the 0° hip-flexion short-lever position (250.1 [70.56] N), P = .32. Hip abduction force outputs were significantly greater (29%) in the 45° hip-flexion position (260.9 [44.43] N) compared with the 0° hip-flexion short-lever position (185.2 [54.84] N), P < .001. Hip adduction:abduction ratio was significantly greater in the 0° hip-flexion short-lever position (1.41 [0.35]) compared with the 45° hip-flexion position (1.03 [0.17]), P < .001, and the 0° hip-flexion long-lever position (0.87 [0.21]), P = .001. The 45° hip-flexion position also demonstrated significantly greater ratios than the 0° hip-flexion long-lever position, P = .052.

Conclusions: These hip adduction:abduction strength ratios should inform practitioners when prescribing strength or rehabilitative exercise to female soccer players. These findings also demonstrate that different testing positions most likely favor different gluteal muscle groups and their respective length tension relationships when the hip position is altered.

Objective: This study examined whether a greater number of recovery sessions combining transcranial direct current stimulation over the dorsolateral prefrontal cortex (+F3/-F4 montage configuration) and pneumatic compression would influence elite professional male soccer players' physiological and perceptual markers.

Design: The intervention occurred during a 3-month period in the competitive season and was applied the day after 17 official matches (match day; MD + 1). Sleep quality, perceived recovery, and creatine kinase concentration were collected during MD + 1 and second day postmatch (MD + 2). The initial sample consisted of 35 players. Data from 14 players who completed 70% of the official match duration and at least 2 experimental recovery sessions were included in the analysis. Players were divided into a high-participation group (>11 experimental recovery sessions) and a low-participation group (<8 experimental recovery sessions).

Results: The high-participation group presented a significantly lower mean creatine kinase concentration (239 [129] International Units per liter [IU·L-1]) (low-participation group; 493 [271] IU·L-1) (P = .04; t = 2.23). No differences were observed between groups for perceived recovery (P = .62; t = .50) and sleep quality (P = .35; t = .95). There were no significant adverse effects.

Conclusions: The unique findings of this study suggest that a greater number of transcranial direct current stimulation sessions combined with pneumatic compression may enhance the recovery process in elite professional soccer players.

Context: Pain catastrophizing, a psychological response to actual or anticipated pain, has been shown to negatively impact attention and is commonly observed in individuals with anterior cruciate ligament reconstruction (ACLR) and other musculoskeletal conditions. In sport settings, attentional changes associated with pain catastrophizing, combined with environmental distractions, may impair injury-related perceptual-motor skills, such as visuomotor reaction time (VMRT). Characterizing the association between pain catastrophizing and VMRT in an environment that simulates sport-related distractions may highlight the need to address psychological factors that impact attention post-ACLR. The purpose of this study was to examine the association between pain catastrophizing and lower-extremity VMRT among individuals with ACLR under conditions with and without sport-specific visual and auditory stimuli.

Design: Cross-sectional.

Setting: Research laboratory.

Methods: Twenty-three participants (age = 20.4 [3.0] y) postunilateral primary ACLR (time since ACLR = 28.6 [13.0] mo). Participants completed the Pain Catastrophizing Scale (PCS) and a lower-extremity VMRT task in a 360° immersive visualization room under 2 conditions: (1) distraction (sport-specific visual and auditory stimuli playing) and (2) control (no sport-specific visual and auditory stimuli playing). Separate multiple linear regression analyses were conducted to examine the association of PCS scores with ACLR and contralateral limb VMRT (milliseconds) in each condition. Time since ACLR was included as a covariate in each model.

Results: In the distraction condition, PCS scores were significantly associated with ACLR limb VMRT (P = .02, β = 2.71), but not contralateral limb VMRT (P = .14, β = 2.65). In the control condition, PCS scores were not significantly associated with lower-extremity VMRT (ACLR limb VMRT: P = .20, β = 2.31, contralateral limb VMRT: P = .45, β = 1.74).

Conclusion: Individuals with ACLR who exhibited greater pain catastrophizing demonstrated slower ACLR limb VMRT when exposed to a simulated sport-related distraction. Evaluating pain catastrophizing in this population may help rehabilitation specialists identify individuals who could experience lower-extremity VMRT changes in environments with sport-related distractions.

Context: Upper-extremity physical performance tests are essential to assess the functional status of athletes. The Closed Kinetic Chain Upper-Extremity Stability Test (CKCUEST) is widely used in sports. However, the psychometric properties of its modified version (MCKCUEST) in swimmers are unknown. We aimed to assess the reliability, standard error of measurement (SEM), minimal detectable change (MDC), and known-group validity of the MCKCUEST in swimmers.

Design: Cross-sectional study.

Methods: We included swimmers of both sexes, aged 12 to 60 years, with and without shoulder pain. Two assessments were conducted with an average interval of 10.37 (3.15) days between them. The MCKCUEST scores were reported as number of touches, normalized score, and power score. Reliability of the MCKCUEST was evaluated using the intraclass correlation coefficient (ICC) (3, 3), SEM, and MDC95. For known-group validity, we compared MCKCUEST scores between swimmers with and without shoulder pain.

Results: Fifty swimmers participated in this study (54% men; 42% with shoulder pain). The MCKCUEST demonstrated excellent reliability (ICC = .90 to .98). The SEM ranged from 1.4 to 1.9 for touches, 5.36 to 7.4 for the power score, and 0.59 to 1.62 for the normalized score. The MDC95 ranged from 4.0 to 5.3 for touches, 11.0 to 20.4 for the power score, and 1.64 to 4.49 for the normalized score. For known-group validity, the asymptomatic group achieved a greater number of touches (mean difference [MD]: 4.5; 95% CI, 0.6-8.4), power score (MD: 23.2; 95% CI, 2.1-44.3), and normalized score (MD: 2.3; 95% CI, 0.03-4.5) than the shoulder pain group.

Conclusion: The MCKCUEST demonstrated excellent reliability for assessing swimmers and adequate known-group validity. The SEM and MDC values observed across all scoring methods were relatively small, indicating low measurement error and the ability of the test to detect meaningful changes in performance over time.

Context: Neuromuscular training (NMT) is an effective injury prevention strategy but may have barriers to in-person delivery. Our objective was to examine injury incidence in the year following NMT intervention delivered virtually and to identify functional test performance associated with subsequent injuries.

Design: Secondary analysis of randomized controlled trial.

Methods: We recruited 40 physically active adults aged 18-40 years. Functional testing included simple (stimulus-response) and clinical (drop stick) reaction time (RT), single- and dual-task tandem gait, vestibular/oculomotor function, and cervical spine proprioception (head repositioning accuracy). Participants were randomized to virtual NMT or control groups. Virtual NMT was an 8-week program delivered via smartphone application, consisting of 3 self-guided sessions/wk. The main outcome was subsequent injuries sustained in the year following study completion.

Results: Forty participants were randomized to intervention (n = 20) or control (n = 20). Thirty-five (87.5%) completed the intervention period. Twenty-four (69%) completed the 1-year follow-up injury survey (age = 26.0 [3.4] y, 71% female; n = 11 intervention and n = 13 control). Five participants reported a subsequent injury, and 19 did not. There was no proportional difference in subsequent injuries between the intervention (27.3%) and control groups (15.4%; P = .63). However, those who sustained subsequent injuries demonstrated significantly slower clinical RT (260.2 [18.7] vs 238.4 [17.3] ms, P = .02, Hedge g = 1.2) and greater head repositioning accuracy error (4.9 [1.8] vs 3.4 [0.8] degrees, P = .007, Hedge g = 1.5). Although not statistically significant, those who sustained injuries demonstrated slower tandem gait (single task: 17.0 [4.2] vs 14.7 [2.4] s, P = .12; dual task: 20.8 [6.2] vs 17.5 [4.1] s, P = .17) and more positive vestibular/oculomotor tests (2.0 [2.3] vs 0.7 [0.95], P = .06) compared to those who did not. Simple RT was similar between groups (467 [64.7] vs 457 [53.5] ms, P = 0.78).

Conclusions: We did not observe a proportional difference in subsequent injuries between virtual NMT and control groups among uninjured adults. However, slower clinical RT and worse cervical spine proprioception may help identify individuals with an increased risk of injuries.

Context: Return to sport assessments after lower-extremity injury/surgery focus on anticipated movement. However, sport requires unanticipated movements with intense visual-cognitive processing. Thus, our purpose was to test the reliability of 2 agility tests augmented with visual-cognitive dual tasks that simulate the attentional demands of sport to improve the ecological validity of return to sport assessments.

Design: Test-retest reliability.

Methods: Twenty-six individuals (17 females, 23.1 [1.8] y, 170.9 [10.2] cm, 71.4 [14.5] kg, Tegner Activity Scale 5.1 [0.7]) participated in 2 study visits, 14 days apart. Each visit, participants completed a (1) Traditional 5-10-5 Shuttle, (2) Reactive 5-10-5 Shuttle (RS), (3) Traditional Agility T-test (AT), and (4) Visual-Cognitive Reactive Agility T test (VCR-AT) in randomized order. Outcomes for the 5-10-5 Shuttles, included fastest reaction time (RS only), split time, and total time. Fastest total time was quantified for the Agility T-tests. Test-retest reliability was established with intraclass correlation coefficients (ICC3,1) using 2-way mixed effects models and 95% confidence intervals. Paired-samples t-tests assessed performance differences between traditional and visual-cognitive conditions (alpha = .05). Dual-task effect (DTE) was expressed by the percent change in performance when a cognitive challenge was added.

Results: Traditional 5-10-5 Shuttle split (ICC3,1 = .97 [.94 to .98]) and total time (ICC3,1 = .99 [.96 to .99]) demonstrated excellent reliability. RS split (ICC3,1 = .96 [.86 to .98]) and total time (ICC3,1 = .96 [.88 to .98]) demonstrated good-to-excellent reliability. RS reaction time (ICC3,1 = .75 [.45 to .89]) demonstrated poor-to-moderate reliability. The RS resulted in slower split (DTE = -24.24%, P < .001) and total time (DTE = -13.31%, P < .001) than the Traditional 5-10-5 Shuttle. AT and VCR-AT total time both demonstrated excellent reliability (AT: ICC3,1 = .97 [.92 to .99]; VCR-AT: ICC3,1 = .97 [.95 to .99]). The VCR-AT resulted in a slower total time (DTE = -1.51%, P = .119) than the AT.

Conclusions: Augmented agility assessments demonstrated good-to-excellent test-retest reliability for all outcomes except RS reaction time. A visual-cognitive dual-task significantly impaired physical performance for the 5-10-5 shuttle but not the Agility T-test. Augmenting agility assessments with visual-cognitive dual tasks is reliable and may improve the ecological lens of return to sport assessments.

Context: Chronic ankle instability (CAI) is prevalent among athletes and is associated with impaired sensorimotor function, reduced dynamic stability, and limited functional movement, increasing the risk of reinjury. Aquatic exercise offers a low-impact alternative to land-based rehabilitation by reducing joint loading and promoting neuromuscular adaptations. This study evaluated the effectiveness of an 8-week aquatic exercise program on functional outcomes in athletes with CAI.

Design: Randomized controlled trial with preintervention and postintervention assessments.

Methods: Forty male athletes (aged 18-30) with clinically diagnosed CAI were randomly assigned to an intervention group (n = 20) which completed an 8-week aquatic exercise program or a control group (n = 20) which continued regular activity without structured rehabilitation. The intervention included 3 weekly aquatic sessions targeting balance, proprioception, and strength. Primary outcomes were functional movement (Functional Movement Screen), dynamic balance (Y-Balance Test), and self-reported ankle function (Cumberland Ankle Instability Tool, Identification of Functional Ankle Instability, Foot and Ankle Ability Measure, Foot and Ankle Ability Measure-Sport). Secondary outcomes included static balance, dorsiflexion range of motion, proprioception, and jumping performance. Repeated-measures analysis of variance and nonparametric tests were used, with P < .05 as significance.

Results: The intervention group showed significant improvements in Functional Movement Screen scores, dynamic balance (P < .001), dorsiflexion range of motion (+19.6%, P < .001), and self-reported ankle function (up to +46.9%, P < .001). Jumping performance significantly improved, with reduced completion times in the side-hop (-18.1%) and 8-line hop (-12.9%) tests, and increased distance in the triple-hop test (+8.5%; all P < .01). Static balance improved in eyes-open condition (P < .001). No significant change occurred in proprioception (P = .506). The control group showed no significant improvements.

Conclusions: An 8-week aquatic exercise program significantly improves functional movement, balance, flexibility, jumping ability, and self-reported ankle function in athletes with CAI. These findings support aquatic therapy as a clinically effective, low-impact rehabilitation option for restoring sensorimotor performance and sport readiness.

Clinical scenario: Sacroiliac joint (SIJ) pain is a type of low back pain, affecting roughly 15% to 30% of patient cases. Pain management is essential for improving function and quality of life in these patients. However, due to the complexity of the anatomy and the innervations surrounding the SIJ, there is limited consensus on the most effective treatment for SIJ pain, resulting in variable approaches to pain management. Common interventions for SIJ pain include muscle energy techniques (MET) and joint manipulations, both are known for their ability to improve function and reduce pain.

Clinical question: In adults with SIJ pain, are joint manipulations or METs more effective in improving function AND reducing pain?

Summary of key findings: Both MET and joint manipulations are effective in treating SIJ pain. The current literature revealed a lack of evidence regarding the sole utilization of MET or manipulation in being more effective in improving function and reducing pain in adults with SIJ pain.

Clinical bottom line: The evidence indicates that both MET and joint manipulations effectively reduce pain and improve function in patients with SIJ pain. However, the literature does not consistently favor one method over the other. Using the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence 2 studies are level 2 and on study is level 3, suggesting that both treatments can be beneficial.

Strength of recommendation: According to the Strength of Recommendation Taxonomy, a grade of C is recommended, indicating that there is fair evidence that is inconclusive but suggests that both treatments can be beneficial.