Journal of Sport Rehabilitation最新文献

Context: Female athletes frequently experience lateral ankle sprains (LAS) during unilateral jump-landing activities and face a significant risk of recurrent ankle injury. LAS has been associated with reduced diaphragm contractility and altered breathing mechanics. The diaphragm and breathing mechanics are crucial for mitigating landing impact, which is typically impaired in individuals with LAS. Given this connection, innovative rehabilitation approaches that address dysfunctional breathing mechanics may be warranted. To date, no research has investigated associations between breathing mechanics and landing kinetics in adolescent female athletes with LAS. This study aimed to compare ground reaction force (GRF) and dynamic stability during a single-leg stabilization task between female athletes with a history of LAS who exhibited diaphragmatic breathing patterns and those who had dysfunctional breathing patterns.

Design: Case-control study.

Methods: Two hundred eighty-three competitive female athletes with a previous history of LAS were recruited from middle school, high school, and Division I college teams. The Hi-Lo test was utilized to categorize participants as dysfunctional breathers or diaphragmatic breathers according to their breathing patterns. Each participant completed 3 trials of a single-leg drop-landing task. Normalized peak vertical and posterior GRF data were extracted, and the average loading rate was calculated from the normalized vertical GRF. The norm of the horizontal component of the GRF was used to calculate time to stabilization.

Results: Forty female athletes with LAS history (14.1%) were classified as diaphragmatic breathers, and 243 (85.9%) were classified as dysfunctional breathers. Female athletes with LAS history who exhibited dysfunctional breathing patterns demonstrated a greater peak posterior GRF (P = .01) and longer time to stabilization (P = .04) compared with those who had diaphragmatic breathing patterns.

Conclusions: Dysfunctional breathing patterns may contribute to decreased dynamic stability and force attenuation capabilities during single-leg landing tasks following LAS. Assessing the biomechanical dimension of breathing patterns may help clinicians identify patient-specific impairments in individuals with LAS, particularly those with deficits in dynamic postural stability and force attenuation.

Assessing cognitive-motor function following anterior cruciate ligament reconstruction may enable a more comprehensive assessment of readiness to return to sport. The primary purpose of this study was determining the relationship between measures of clinical cognitive-motor interference and laboratory-based second injury relevant biomechanics through a cross-sectional study.

Methods: Thirty-six individuals following anterior cruciate ligament reconstruction (26 females/10 males, 19.8 [1.8] y; 1.7 [0.1] m; 69.6 [12.8] kg, Tegner activity level 6.8 [1.8], 1.5 [0.6] y post anterior cruciate ligament reconstruction) participated in the study. We assessed 2 clinically feasible tests of cognitive-motor function: single (ST) and dual tasks (DT) for triple hop and medial-side hop. Laboratory-based tests involved motion capture assessment of jump landings from a 30-cm box followed immediately by a secondary jump. Conditions included, ST (anticipated secondary jump direction) and DT (unanticipated secondary jump direction). Primary outcome variables included DT change (DTC) of second anterior cruciate ligament injury predictors (limb asymmetry in knee extensor moment at initial contact, range of knee abduction angle for the involved limb, and uninvolved hip rotation net moment impulse). Correlations were used to identify associations between lab- (biomechanics) and clinic-derived (hop distance) outcomes. Secondary analyses with other risk-associated knee mechanics and patient-reported outcome measures were also performed.

Results: No significant correlations were found between DTC clinical variables and DTC second anterior cruciate ligament predictors. However, significant relationships were observed between clinical and lab outcomes when considering ST or DT in isolation, such as ST range of knee abduction angle for the involved limb correlating with ST for triple hop for both limbs (Inv: r = -.436, Padj = .04; Uninv: r = -.453, Padj = .04).

Conclusions: Associations between cognitive-motor interference (ie, DTC) in clinical and lab tests were not found, but significant fair strength correlations appeared between clinical and lab variables when examining ST and DT performance, separately. Future prospective studies are needed to determine the predictive value of cognitive-motor function for injury rehabilitation decision making.

Clinical scenario: Patellofemoral pain (PFP) places a large burden on patients and the larger health care system. Current best evidence suggests an impairment-driven approach to managing PFP. Deep-dry needling (DDN) is a potentially advantageous manual therapy for patients with PFP due to the proposed benefits, including improved blood flow and oxygen saturation, improved range of motion, and improved muscle extensibility and function. However, current best practices do not recommend the utilization of DDN in the management of PFP and fail to evaluate DDN as part of multimodal treatment, and only evaluate DDN of the quadriceps muscle group. This critically appraised topic evaluates the literature on inclusion of DDN as part of the multimodal treatment of PFP exploring multiple muscle groups impacting PFP.

Clinical question: In patients with PFP, does the inclusion of dry needling within a multimodal treatment program result in improved patient outcomes?

Summary of key findings: Fifteen articles were screened for inclusion criteria and 3 randomized controlled trials were accepted for inclusion. All 3 articles evaluated Dry Needling + Exercise versus Exercise. One of these articles evaluated Dry Needling of the quadriceps muscle group, and the other 2 evaluated Dry Needling of the posterolateral hip musculature. The studies that evaluated the posterolateral hip musculature found significant improvements in patient-reported outcomes over the control group. The study that evaluated the quadriceps muscle group found no added benefit of including Dry Needling with conventional exercise programs.

Clinical bottom line: There is limited level 1b evidence to support the utilization of DDN within the multimodal management of PFP. Current literature supports DDN of posterolateral hip musculature over DDN of the quadriceps muscle group. Management of PFP should be guided by an impairment-driven approach.

Strength of recommendation: SORT Grade of B based on limited level 1b evidence.

Objective: This study aimed to differentiate subgroups of chronic ankle instability (CAI), including mechanical ankle instability (structural damage), functional ankle instability (FAI: neuromuscular deficits), Copers (individuals who recovered functional stability without recurrent symptoms), and controls (healthy individuals), using a validated questionnaire set (Cumberland ankle instability tool [CAIT], identification of functional ankle instability [IdFAI], ankle instability instrument [AII], foot and ankle ability measurement [FAAM]/Activities of Daily Living, FAAM/Sports). Additionally, we sought to present a standardized scoring system to classify CAI, Copers, and control participants.

Design: Case-control study.

Methods: A total of 104 people participated in the study, including 26 mechanical ankle instability, 26 functional ankle instability, 26 Copers, and 26 healthy controls. The Kruskal-Wallis test was used for analysis, and the Mann-Whitney test was used for post hoc tests. The cutoff value for each group was confirmed using the receiver operating characteristic curve.

Results: Analyses comparing the CAI, Copers, and control groups revealed significant differences in CAIT (P < .001), IdFAI (P < .001), AII (P < .001), FAAM/Activities of Daily Living (P < .001), and FAAM/Sports (P < .001). The cutoff values for each group were confirmed for CAIT, IdFAI, AII, FAAM/Activities of Daily Living, and FAAM/Sports. For CAIT, it was 0 to 8.5 mechanical ankle instability, 8.6 to 23 for functional ankle instability, 24 to 29.5 for Copers, and 29.6 to 30 for control.

Conclusion: These findings support using CAIT, IdFAI, and AII to classify CAI subtypes and identify Copers. Questionnaire-based cutoff values may assist rehabilitation planning and clinical decision-making. A CAIT score below 8.5 may indicate surgical consideration, supported by comprehensive clinical assessment.

Context: Individuals with chronic ankle instability (CAI) have deficits in force accuracy in evertors and hip abductors due to impaired neuromuscular control. Individuals with CAI rely more on visual information during force accuracy following lateral ankle sprain. To identify the effects of using stroboscopic glasses following a 4-week rehabilitation on force accuracy of ankle evertors, invertors, and hip abductors and visual reliance in individuals with CAI.

Design: Randomized controlled clinical trial.

Methods: A total of 50 CAI individuals were assigned to a strobe or control group. The strobe group wore stroboscopic glasses during rehabilitation, while the control group did not. Force accuracy was measured at 10% and 20% of maximum voluntary isometric contraction (MVIC). Romberg ratios were calculated as strobe vision/eyes open to identify visual reliance.

Results: The strobe group showed a greater force accuracy in 10% of evertors MVIC under the strobe vision than the control group. The strobe group showed a greater force accuracy in 10% of evertors MVIC under the strobe vision than with the eyes open. The strobe group showed an improved Romberg ratio in 10% of evertors MVIC between the pretest and posttest.

Conclusion: Stroboscopic glasses may offer clinicians a new means to reduce visual reliance, allowing them to utilize the somatosensory system more effectively around the foot/ankle complex. This may indicate reweighting of sensory systems in CAI individuals during rehabilitation.

Context: Sport injuries continue to be unavoidable disruptions in student-athletes' athletic careers. Researchers continue to emphasize the importance of an interprofessional approach to rehabilitation to help athletes manage the adverse psychological and emotional reactions to injury.

Objective: To extend and replicate the research of Clement and Arvinen-Barrow by incorporating perspectives of Division I US student-athletes. The current study describes 321 NCAA Division I college athletes' experiences of receiving interprofessional care during injury rehabilitation and second, to explore perceptions of, and access to, sport psychology professionals during rehabilitation.

Design: A multimethod, cross-sectional survey where participants were asked to complete a multidisciplinary team categorization tool (eg, primary vs secondary), a modified version of the Social Support Survey, open-ended questions, injury details, and demographic variables.

Methods: After several rounds of email and in-person recruitment lasting approximately 3 months, 321 Division I student-athletes across 16 NCAA conferences participated in the cross-sectional study.

Results: Athletes most commonly placed athletic trainers, athletic coaches, and strength and conditioning coaches on the primary rehabilitation team. Additionally, athletic coaches, strength and conditioning coaches, and teammates were most frequently identified as secondary rehabilitation team members.

Conclusions: Overall, mental health support was the most commonly identified item related to missing services. For those that did work with one of these professionals, the main themes that emerged were helpfulness of a safe space and feeling supported beyond sport. This study provided support for the use of the multidisciplinary model of sport injury rehabilitation within the context of college athletics.

Context: This study investigates the main effects of axial spine posture, gender (as a dummy variable), and training years, along with the interaction of training years with postural parameters, on upper-extremity functional performance in overhead athletes.

Design: Cross-sectional study.

Methods: A total of 135 athletes participated in the study, including 57 healthy male and 78 female athletes. Photographic posture analysis and functional performance tests were utilized to assess static posture parameters and the athletic performance respectively. Multiple linear regression analysis was conducted to explore statistically significant variables and estimate their coefficients, examining the relationships among static posture alignment variables, years of training, their interaction with postural variables, and gender as a control variable, with performance metrics as the outcome.

Results: The findings revealed significant effect of gender in Upper Quarter Y Balance Test Dominant (B = 4.36, P < .05), Closed Kinetic Chain Upper-Extremity Stability Test (B = 2.77, P < .05), and both Unilateral Seated Shot-Put Test Dominant (B = 173.46, P < .05) and nondominant sides (B = 148.00, P < .05), with males outperforming females. Nondominant C7 tragus alignment interacting with training years significantly predicted Upper Quarter Y Balance Test Dominant (B = 0.20, P < .01) and Unilateral Seated Shot-Put Test Dominant (B = 0.98, P < .05) and Nondominant (B = 0.89, P < .05) performance, while thoracic kyphosis interacting with training years significantly affected the Unilateral Seated Shot-Put Test Nondominant side (B = -0.24, P < .05).

Conclusions: Gender-related differences in lumbar lordosis and thoracic kyphosis suggest biomechanical variations impacting postural control and injury risk. Training-induced spinal adaptations highlight the role of sport-specific loading. These findings support the need for personalized training programs tailored to gender and training history to optimize performance and reduce injury risk, with future research recommended to include dynamic postural assessments for a deeper understanding of posture-performance relationships.

The objective of this pilot study was to compare the effects of aquatic therapy and land-based rehabilitation on gait symmetry and muscle properties following anterior cruciate ligament reconstruction (ACLR). The study comprised 20 postoperative ACLR patients in a pilot randomized controlled trial. Participants were divided into 2 groups: an aquatic therapy group (n = 10) and a land-based rehabilitation group (n = 10). Both rehabilitation programs were tailored to individual patient needs. Gait parameters were assessed using a high-speed camera before and after the intervention, while muscle tone and stiffness were measured using MyotonPRO. The study findings reveal a significant difference in step length symmetry between the 2 groups postintervention. Within-group analysis showcased noteworthy improvements in the aquatic therapy group, including enhanced single-support phase duration symmetry, reduced vastus lateralis muscle tone on the affected side, and enhanced hamstring muscle tone on the affected side. Conversely, the land-based rehabilitation group demonstrated significant increases in stiffness solely within the affected vastus lateralis. The study suggests aquatic therapy as a viable postoperative option following ACLR. While land-based rehabilitation has its benefits, aquatic therapy shows superior effectiveness in normalizing gait symmetry and restoring muscle properties.

Context: Individuals with chronic ankle instability (CAI) have deficits in postural control. Previous studies assessing postural control have been limited by minimal environmental perturbations. The purpose of this study is to identify the effects of virtual reality (VR)-based perturbation on static postural control among CAI individuals, copers, and healthy controls.

Design: Cross-sectional study.

Methods: A total of 60 participants (20 individuals with CAI, 20 copers, and 20 healthy controls) performed 3 trials of a single-leg stance for 10 seconds with eyes open and eyes closed (EC) and VR. Static postural control was analyzed by 2-way analysis of variance.

Results: CAI individuals showed worse static postural control in the center of the pressure mediolateral range and ellipse area under VR than copers and healthy controls. Copers showed better static postural control in the center of pressure mediolateral range and in the ellipse area under VR and EC than individuals with CAI and healthy controls. Both VR and EC resulted in worse static postural control than eyes open across the 3 groups. However, there were no differences in static postural control between VR and EC within each group. CAI individuals demonstrated worse static postural control under VR than copers and healthy controls, whereas copers exhibited better postural stability under VR than CAI individuals and healthy controls.

Conclusions: VR may serve as a means for understanding differences in postural control mechanisms in individuals with CAI and copers.

Context: Studies have yet to demonstrate how attentional focus strategies affect dynamic balance in the Lower Quarter Y-Balance Test and its testing properties. This study aimed to examine the effects of verbal instructions and focus techniques on dynamic balance performance during the Lower Quarter Y-Balance Test and to assess the reliability of these techniques.

Design: Cross-sectional study.

Methods: The study involved 52 healthy individuals (mean age: 23.1 y, mean body mass index: 22.3 kg/m2). Standard, internal focus, and external focus instructions were randomly applied during Lower Quarter Y-Balance Test. Test-retest evaluations conducted within 3 to 5 days.

Results: Analysis of variance revealed a significant difference only in the anterior direction among instructions (F2,102 = 6.851, P = .002). External focus instruction in the anterior direction produced slightly higher results than both standard (mean difference% = 2.91, P = .005) and internal focus instruction (mean difference% = 2.91, P = .005), though this change was relatively small. Intraclass correlation coefficient values indicated excellent reliability (intraclass correlation coefficient: .87-.93) for all directions with internal and external focus instructions, except for the posteromedial direction and composite score with standard instructions (intraclass correlation coefficient: .70-.77).

Conclusions: The findings imply that including external focus instructions in dynamic balance evaluations can positively impact performance results as well as the reliability of the assessments. This enhancement in reliability may facilitate better-informed decisions in clinical and athletic settings.