Journal of Sport Rehabilitation最新文献

Background: Diastasis rectus abdominis is a condition in which the rectus abdominis muscles separate and move laterally, causing stretching of the linea alba tissue with weakness of the abdominal wall. Although it can lead to hernia of the abdominal viscera, diastasis rectus abdominis is not a hernia in itself. This condition is common among women during pregnancy and the postpartum period and can significantly affect their quality of life and their return to sports activity. Unfortunately, information on the incidence, risk factors, prevention, and treatment of diastasis rectus abdominis are limited.

Methods: We conducted a pilot prospective observational study on 37 patients who practiced sports at high levels (at least 3 times a week with amateur/competitive competitions) who underwent ultrasound measurements of the distance between the rectus abdominis muscles at the level of the xiphoid process, supraumbilical, umbilical, and subumbilical at time (T0), after 2 months from the rehabilitation protocol (T1), and then after 4 months of rehabilitation protocol (T2) from approximately 3 months after giving birth, and we saw an early return to sport.

Results: Our data analysis reveals that there is an initial decrease in diastasis during the first 2 months with 3 weekly physiotherapy activity sessions in all 4 measurements. One session takes place on site with physiotherapists, while the other 2 are carried out at home using the rehabilitation protocol provided by the medical staff. At the 4-month follow-up, the improvement was similar to the previous follow-up.

Conclusion: Of the 37 women analyzed, 6 were referred to the surgeon; 2 for hernias and 4 for diastases greater than 4 cm. The remaining women benefited from a conservative approach. Patients undergoing the rehabilitation protocol showed improvements in all 4 measures, as well as their early return to sport.

Context: This case study demonstrates the effectiveness of early surgical excision of the traumatic myositis ossificans of the vastus intermedius muscle in an elite football player and return to sports activity within 3 months from the initial injury.

Case presentation: A 27-year-old male professional football player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion 4 weeks earlier. After unsuccessful conservative therapy, the differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. MRI revealed significant edema encompassing a substantial portion of the vastus intermedius muscle.

Management and outcomes: Surgical treatment was considered for the right thigh mass, being symptomatic 1 month after the onset and refractory to conservative treatment and rehabilitation program. At 2 months postsurgery, the patient was asymptomatic and had completed a rehabilitation program.

Conclusion: Early surgical treatment followed-up with a rehabilitation program results with a complete recovery of muscle strength and range of motion. At 3 months postinitial injury, the patient was considered fully recovered and had returned to the match without reporting pain or other symptoms.

Context: Limited information exists regarding the immediate and short-term effects of scapula retraction exercises (SREs) on acromiohumeral distance (AHD) in subacromial pain syndrome (SPS). This study's 2 main objectives were to investigate (1) the immediate effect of the SRE on AHD at varying shoulder abduction angles in patients with SPS and healthy controls and (2) the effect of the 8-week SRE program on AHD in patients with SPS.

Design: Cross-sectional and pre-post intervention designs were utilized on this study.

Methods: Twenty-one patients with SPS and age-matched healthy controls were included. First, AHD at 0°, 30°, 45°, 60°, and 90° of active shoulder abductions were recorded during (1) resting upper quadrant posture and (2) while participants were performing SREs. Patients then underwent an 8-week progressive SRE program. AHD measures, pain intensity (visual analog scale), and disability (Shoulder Pain and Disability Index) were recorded at baseline and 8 weeks. AHD were analyzed using mixed-model analyses of variance. Pain and disability were analyzed using paired samples t test.

Results: The immediate effect of the SREs revealed a significant angle-by-exercise-by-group interaction for the AHD values (F3,155 = 3.956, P = .009, ηp2=.175). Pairwise comparisons yielded that the SRE increased AHD values in patients with SPS (P < .05), yet it did not affect healthy controls (P > .05). Besides, the SRE program revealed a significant angle-by-time interaction for the AHD values (F3,054 = 9.476, P < .001, ηp2=.195). AHD increased at all elevation angles, and pain and disability improved over time (P < .05).

Conclusion: SREs immediately affect AHD in patients with SPS but not in healthy populations. Moreover, SREs applied in progressive abduction angles improve pain, functionality, and AHD values in patients with SPS.

Context: In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes.

Design: Secondary analysis of prospectively collected clinical data.

Methods: 600 youth with concussion were included. Active rehabilitation was initiated ≥4 weeks (prepolicy) or ≥2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted.

Results: The postpolicy group (median = 22 d [interquartile range: 17-27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24-30], P < .001). Length of episode of care (χ2(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19-1.88); rehabilitation (χ2(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22-2.45]); and total recovery (χ2(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18-1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F2,320 = 3.59, P = .03) and symptom change scores (F2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms.

Conclusions: Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.

Context: To further improve rehabilitation programs while preventing overstretching the anterior cruciate ligament (ACL), a thorough understanding of the knee kinematics and ACL length change during closed kinetic chain and open kinetic chain (OKC) exercises is essential. The measurement of ACL graft length relates to the changes in strain experienced by the ACL graft during different types of exercises rather than simple physical length.

Objective: This study aimed to determine the effects of closed kinetic chain and OKC exercises on tibiofemoral kinematics and ACL graft length changes following double-bundle ACL reconstruction.

Design: Cohort study (diagnosis); level of evidence, 3.

Setting: Laboratory.

Patients: Fifteen patients who underwent double-bundle ACL reconstruction were asked to perform 10-kg loaded seated knee extension (OKC-10) and single-leg lunge. During the seated knee extension, patients were instructed to extend and flex the knee within a range of 0° to 90° of flexion, with a 10-kg load applied to the ankle. For the lunge, patients began in a natural standing position and were instructed to flex the ACL-reconstructed knee to approximately 90°.

Interventions: The 3-dimensional tibiofemoral kinematics under different weight-bearing conditions were determined using a dual-fluoroscopic imaging system.

Main outcome measures: The tibiofemoral kinematics in 6 degrees-of-freedom were measured. And 3-dimensional ligament simulation technique was used to quantify length changes of the anteromedial bundle and posterolateral bundle.

Results: The tibia exhibited significantly more external rotation during the OKC-10 motion than during the single-leg lunge from 35° to 70° of knee flexion (P ≤ .028). Beyond 30° of knee flexion, the tibia exhibited significantly more varus during the OKC-10 motion than during the single-leg lunge (P ≤ .028). And a significantly more anterior tibial translation was observed during the OKC-10 motion than during the lunge from 0° to 15° of flexion (P ≤ .018). The anteromedial bundle length was significantly longer during the OKC-10 motion than during the lunge between 0° and 25° of knee flexion (P ≤ .028).

Conclusions: The effects of OKC exercises with loads on knee rotational stability should be considered in making rehabilitation programs for patients after ACL reconstruction. Since some degree of anterior tibial translation is physiological, it is important to note that increased translation alone does not necessarily indicate danger or instability.

Context: After completing rehabilitation, patients face a high risk of subsequent injury following anterior cruciate ligament reconstruction. It is important to identify potential barriers to patient success including clinician knowledge. The purpose of this study was to assess clinician knowledge of research related to anterior cruciate ligament reconstruction rehabilitation.

Design: This was a survey study using snowball sampling.

Methods: Survey development began with the creation of a construct map and contained varying levels of advanced concepts, level I indicating the most basic and level V the most complex. The survey was distributed to advertise to target population. A total of 60 participants (24 athletic trainers, 33 physical therapists, and 3 dual credentialed) completed the study.

Results: Overall, participants displayed moderate to high levels of knowledge (79.7%-93.5% correct), apart from the implementation of motor learning principles.

Conclusions: Clinician knowledge may not be the primary barrier to patient success, but the implementation of this knowledge should be explored in relation to patient outcomes. Future research should examine a larger cohort to examine differences between clinician types.

Context: Athletes with a history of concussion (CON) have been demonstrated to have heightened levels of anxiety and depression that may continue well beyond the resolution of concussion symptoms. The global events of 2020 resulted in elevated levels of anxiety and depression in the general population, which may have unequally presented in collegiate athletes with (CON) than those without a history of concussion (NoCON). Using a deception design, our survey-based study compared levels of anxiety and depression in CON and NoCON collegiate athletes in response to the pandemic and social injustices. We hypothesized that the CON group would have significantly elevated anxiety and depression as compared to the NoCON group in response to events of 2020.

Design and methods: Collegiate athletes (N = 106) during the academic 2020-2021 academic year were divided into CON and NoCON groups based on their preinjury (baseline) concussion assessment. Participants completed the Social Readjustment Rating Scale (SSRS), Center for Epidemiologic Studies Depression Scale (CES-D), and Generalized Anxiety Disorder Scale-7 (GAD-7) via an electronic survey pertaining to the events of 2020. The term "concussion" was not used in any study materials which was the basis for our deception-based design. An analysis of covariance was used to compare group CES-D and GAD-7 outcome scores while controlling for the SSRS outcome score.

Results: Our survey response rate was 14.2% (48/337 [77.1% female]) and 10.1% (58/580 [67.2% female]), for the NoCON and CON groups, respectively. The NoCON group had significantly (F1 = 5.82, P = .018, ηp2=.06) higher anxiety (8.3 [5.89]) as compared to the CON group (5.5 [2.85]). The NoCON group also had significantly (F1 = 13.7, P < .001, ηp2=.12) higher levels of depression (21.0 [12.52]) as compared to the CON group (16.07 [9.10]).

Discussion: Our deception-based study revealed NoCON participants had elevated and clinically relevant mood states as compared to CON participants in response to the events of 2020.

Context: Targeted and directed rehabilitation with a healthcare provider can be an effective approach in the treatment of concussion, particularly for patients with protracted recovery, high symptom reporting, cervicogenic dysfunction, musculoskeletal involvement, and/or vestibular/oculomotor dysfunction. While many environmental and intrinsic medical history factors may influence concussion recovery, little is known about whether an individual's recovery trajectory can be influenced by the amount of time taken to receive rehabilitation. The purpose of this study was to evaluate recovery trajectories of concussion patients requiring targeted multimodal rehabilitation after a specialty concussion clinic visit within ≤3 days, 4 to 7 days, and >7 days. We also sought to evaluate risk factors for protracted recovery.

Design and methods: The study involved a retrospective chart review of 103 patients (mean age = 13.78 [2.89]; 55% female) who, after their initial specialty concussion clinic visit, received rehabilitation in ≤3 days, 4 to 7 days, and >7 days. Patients were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023, and diagnosed with concussion by a specialist (primary care sports medicine physician, nurse practitioner, and/or neuropsychologist), referred for rehabilitation via physical therapy services, completed more than one rehabilitation session, and received medical clearance to initiate the return-to-sport protocol. Groups were compared based on relevant clinical factors, Vestibular Ocular Motor Screening, neurocognitive testing (Trails B-A), Post-Concussion Symptom Scale, days from injury to concussion evaluation, days from concussion evaluation to rehabilitation, number of rehabilitation sessions, recovery days after rehabilitation, and total recovery days (ie, days from injury to medical clearance to initiate return-to-sport protocol). Data analysis included chi-square, correlations, 1-way analysis of variance, and general linear regression. Adjusted odds ratios for protracted recovery were derived from a logistic regression model.

Discussion: Days from injury to concussion evaluation (P < .001), days from concussion evaluation to rehabilitation (P = .006), and Trails B-A (P = .009), were significant predictors of total recovery time among pediatric concussion patients who required multimodal rehabilitation. Risk of protracted recovery increased by 34% each day from injury to concussion evaluation a patient did not receive treatment (Nagelkerke Pseudo R2 = .45; P < .001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to concussion care and rehabilitation for patients with a need for multimodal rehabilitation can improve recovery outcomes.

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG's low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician-scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.

Context: A common component within rehabilitation recommendations for baseball pitchers is employment of an interval throwing program. However, there is a lack of a consistent set of advocated guidelines for program content and implementation for athletes at the professional and collegiate levels.

Design: Cross-sectional study.

Methods: A survey was developed to obtain clinician views regarding the composition and implementation of interval throwing programs for baseball pitchers. The survey was divided into demographic information and sections on criteria to begin throwing programs, frequency of throwing, soreness management, warm-up components, program components and regulation of a program, and criteria to achieve permitting live throwing. Clinicians including physicians, physical therapists, and certified athletic trainers who evaluate and treat musculoskeletal injuries among baseball pitchers at the professional-level and/or collegiate-level clinician received the survey. Responses were tabulated and compared between the professional-level clinician and collegiate-level clinician groups using chi-square analyses with statistical significance set at P ≤ .05.

Results: The survey was completed by 166 clinicians (collegiate level = 81, professional-level clinician = 85). There were no statistical differences between groups for allowing warm-up throws, program regulation, maximum distance allowed, managing soreness, or criteria to achieve before permitting live throwing. Between-group differences included criteria to begin a program (≤.03), warm-up distance (P ≤ .02), nonthrowing warm-up methods (P ≤ .04), non-warm-up distance (P ≤ .01), using ratings of perceived exertion (P < .01), throwing frequency (P < .01), and program components (P ≤ .04).

Conclusions: Responses appear to mirror interval throwing program designs previously reported in the literature but there are modifications and additions utilized by clinicians at different playing levels.