Journal of Sport Rehabilitation最新文献

Context: Distal plantaris tendon rupture is an exceptionally rare injury, often misdiagnosed as Achilles tendinopathy or partial Achilles rupture due to overlapping symptoms and anatomical proximity. While the plantaris muscle contributes minimally to plantarflexion force, its proprioceptive function may be relevant in high-performance athletes.

Case presentation: We present 2 cases of distal plantaris tendon rupture in professional football players, including one athlete with bilateral rupture on separate occasions. Both sustained acute posterior ankle pain during eccentric dorsiflexion and heel-rise test without a palpable defect. High-resolution ultrasound confirmed isolated plantaris tendon rupture, allowing for timely diagnosis and management.

Management and outcomes: Both athletes underwent conservative rehabilitation, emphasizing progressive loading, proprioception training, and sport-specific reintegration. They returned to full competition within 4 weeks without complications.

Conclusions: Distal plantaris tendon rupture, though rare, should be considered in differential diagnoses of acute Achilles pain. Ultrasound is a valuable diagnostic tool, and structured rehabilitation ensures rapid recovery. The bilateral rupture in one athlete raises concerns about intrinsic risk factors, warranting further research into biomechanical and anatomical predispositions in elite sports.

Clinical scenario: Knee-extensor strength training is commonly used in patients with knee osteoarthritis (KOA) to improve muscle function, mobility, and quality of life. For typical complaints that result in significant movement limitation or even immobilization, unilateral knee-extensor strength training of the unaffected or less affected limb to induce a cross-education (CE) effect in the contralateral affected limb may be a possible but understudied treatment option.

Focused clinical question: Does unilateral knee-extensor strength training lead to CE effects in the contralateral affected limb in patients with KOA?

Summary of key findings: Results from 2 randomized controlled/clinical trials (level 1b) and 1 quasi-experimental study (level 2) provided limited grade B evidence for the CE effect of unilateral knee-extensor strength training to improve maximal knee-extensor strength of the affected limb in patients with KOA.

Clinical bottom line: Based on the current literature, unilateral knee-extensor strength training induces a significant CE effect in the contralateral affected limb by increasing maximal knee-extensor muscle strength in patients with KOA, but there is no consensus on the exact nature of the adaptations and whether different types of muscle contractions during training are superior to each other.

Strength of recommendation: Due to limited evidence (grade B), the true CE effect of unilateral knee-extensor strength training of the unaffected or less affected limb to improve maximal knee-extensor strength of the contralateral affected limb in patients with KOA remains unclear and needs further investigation.

Context: It is recommended that arterial occlusion pressure (AOP) should be measured prior to the use of blood flow restriction training. Previous studies have not compared measures of AOP when using 2 methods of cuff inflation commonly reported in the literature.

Design: A cross-sectional observational study was used to compare the measurement of brachial artery AOP as measured using pulse wave Doppler ultrasound (PWDOP) and continuous wave Doppler ultrasound (CWDOP) devices when inflating the cuff with a research/clinical-grade Hokanson (HOK) rapid cuff inflation system and manually (MAN) with a hand pump and gauge.

Methods: We made simultaneous measures of brachial artery AOP in 20 males and 21 females using PWDOP and CWDOP devices when using HOK and MAN cuff inflation methods. Data were analyzed with a linear mixed model analysis of variance and Bland-Altman plots.

Results: There was not a significant main effect for the overall differences in AOP as measured using PWDOP (121.7 ± 14.7 mmHg) and CWDOP (121.3 ± 14.5 mmHg; P = .3641). There was a significant overall main effect for AOP measured using the HOK (122.7 ± 14.6 mmHg) and MAN (120.3 ± 14.6 mmHg) cuff inflation methods (P < .0001) and between males (128.2 ± 13.7 mmHg) and females (115.2 ± 12.5 mmHg; P = .0034). Bland-Altman plots revealed minimal bias and reasonable limits of agreement between PWDOP and CWDOP measures of AOP when using HOK (0.8 mmHg; 95% CI, -4.7 to 3.0 mmHg) and MAN (0.4 mmHg; 95% CI, -5.3 to 4.5 mmHg) cuff inflation methods.

Conclusions: The cessation of an audible pulse using CWDOP is in agreement with the complete obstruction of the arterial blood flow observed using PWDOP. Although statistically significant, small differences in PWDOP and CWDOP measures of AOP when using HOK and MAN cuff inflation methods are of little practical significance. A hand-held CWDOP device and a handpump/gauge can be used to measure AOP.

Objective: To examine the effects of incorporating (1) a neurocognitive reactive component and (2) a neurocognitive multitask component on performance degradation of a single-limb hop functional performance test.

Design: Randomized within-subject design of 32 healthy young adults.

Methods: Participants performed 3 randomly assigned variations of the single-limb T-Drill Hop Test (TDHT). The time to complete each test was recorded. The reactive TDHT (R-TDHT) consisted of the TDHT with a flashing light, indicating the "T" intersection hop direction. The neurocognitive reactive-recall TDHT (RR-TDHT) incorporated the R-TDHT and required participants to observe 5 flashing light colors. Participants then recalled the colors in order at test completion. Each test was performed on the dominant and nondominant lower extremities in a randomly assigned order. Within-group differences in completion time between tests were calculated using a test by limb analysis of variance.

Results: Test complexity prompted similar completion time changes between the limbs (P = .718, ηp2=.011). The R-TDHT (P = .001, d = .12) and RR-TDHT (P < .001, d = 0.24) completion times were significantly longer than the TDHT, and the RR-TDHT completion time was significantly longer (P < .001, d = 0.11) than the R-TDHT. The completion time differences between TDHT and R-TDHT and between R-TDHT and RR-TDHT were statistically identical (P = .770, d = 0.05). There was no statistically significant completion time difference between the dominant and nondominant limbs (P = .420, d = 0.06).

Conclusion: The inclusion of a neurocognitive reactive activity and a multitask neurocognitive reactive-recall activity to a functional performance test significantly increased the test completion time compared with the functional performance test alone. The addition of a neurocognitive reactive component or a multitask neurocognitive reactive-recall component to the TDHT provides an effective means of improving the ecological validity of the current lower extremity functional performance test.

Clinical scenario: Anterior cruciate ligament (ACL) injuries remain one of the most common and debilitating injuries that physically active individuals experience. Pain-related fear of movement and/or reinjury, or kinesiophobia, is the most frequently cited reason for not returning to sport after ACL reconstruction. Understanding how kinesiophobia may impact recovery of physical performance is essential to guide targeted rehabilitation.

Clinical question: Does kinesiophobia associate with physical performance in patients with a history of ACL reconstruction?

Summary of key findings: Five cross-sectional studies investigating bivariate relationships between kinesiophobia and metrics of physical performance among individuals with a history of primary, unilateral ACL reconstruction were included. From a strength perspective, greater kinesiophobia associated with lesser isometric knee flexion torque (n = 1, negligible association) but did not associate with isokinetic or isometric knee extension torque (n = 2). In terms of functional movement, greater kinesiophobia associated with asymmetric single-leg step-down performance (n = 1, high association) and shorter single-leg hop distance (n = 1, negligible association). Biomechanically, greater kinesiophobia associated with worse drop jump landing, characterized by greater frontal plane motion and lesser sagittal plane motion at the hip and knee joints (n = 1, low to high association).

Clinical bottom line: Very low-quality evidence suggests a muscle-specific association between kinesiophobia and strength. Low- to moderate-quality evidence suggests that greater kinesiophobia associates with worse functional movement and landing biomechanics.

Strength of recommendation: Considering the consistency and level of evidence among the included studies, we offer the following grades for each construct of physical performance evaluated: strength, D; functional movement, B; and biomechanics, B.

Context: Football players aged 15-20 years experience injury incidence rates similar to those of professionals, with players injured in this age group being significantly less likely to reach the professional level. Understanding the factors that influence young footballers' acceptance, adoption, and compliance with injury prevention programs is crucial. Therefore, this study aimed to describe the perceptions of male football players from premier league academies regarding injury risk factors and prevention strategies.

Design: Cross-sectional observational study.

Methods: An online survey was used to explore perceptions of injury risk factors and prevention strategies among young football players (under-17 and under-20 teams) from premier league academies.

Results: A total of 504 footballers (mean age: 18 [2] y) across 9 academies in 8 different cities participated in this study. No risk factor was elected as very important by at least half of participants. The top 5 injury risk factors elected by players were "poor hydration," "inadequate warm-up," "poor rest/sleep," "inadequate diet," and "poor strength/power." At least 1 quarter of participants considered "genetics," "advanced age," "attention level," "wheatear conditions," and "alcohol consumption" as irrelevant factors for injury. There was no consensus for any prevention strategy. Fourteen strategies were ranked as efficient by at least 3 quarters of participants. The top 5 prevention strategies elected by players were "warm-up before training/matches," "functional training," "hydration before and during training/matches," "flexibility training," and "workload monitoring." Lower than a half of participants endorsed "ankle braces" and "thermal shorts" for injury prevention.

Conclusions: The results of this study offer valuable insights into the perceptions of elite young football players regarding injury risk factors and the effectiveness of preventive strategies. These perceptions are essential for understanding how athletes view injury prevention approaches in their daily routines.

Clinical scenario: Anterior cruciate ligament (ACL) injury risk may increase when certain movements are noted during landings. Initial ACL injury produces poor long-term outcomes for patients. Movement assessments may help predict risk of initial ACL injuries.

Clinical question: Are movement assessments predictive of initial ACL injuries in college/high school athletes?

Summary of key findings: Six articles met the inclusion criteria. Some movement assessments did not predict ACL injury. However, the functional movement screen composite score of 14 or less and landing error scoring system scores of 5 or greater were found to be associated with an increased risk of an ACL injury. Knee valgus angles of ≥6.5 cm were associated with future knee injury but only had fair predictive validity.

Clinical bottom line: There are conflicting results on whether movement assessments can accurately predict primary ACL injuries. However, clinicians can consider the use of the functional movement screen composite score (14 or less) and the landing error scoring system score (5 or greater) as both may predict a future ACL injury. More research is needed to uncover movement assessments that better predict ACL injury.

Strength of recommendation: A grade B recommendation can be given that movement assessments may be used for screening for initial ACL injury.

Background: Compression socks are a popular feature for runners and are widely advertised by the industry. Limited high-quality evidence has summarized the effects of compression socks during running. We aimed to investigate the effects of wearing compression socks compared with placebo or regular socks during running on physiological parameters, running performance, and perceptual outcomes.

Methods: The protocol was registered at PROSPERO (CRD42022330437). Five databases (MEDLINE, Embase, CINAHL, SPORTDiscus, and Web of Science) were searched. Clinical trials exploring the effect of compression socks during running on physiological parameters, performance, and perceptual outcomes were included. The Cochrane risk of bias 2 tool was used to assess the risk of bias.

Results: We included 28 trials (600 runners), with 16 trials (284 runners) contributing to meta-analysis. For physiological outcomes (eg, heart rate mean difference [95% CI = 0.82 [-0.39 to 2.03] and blood lactate concentration mean difference [95% CI] = 0.30 [-0.39 to 0.98]), pooled analysis indicated low to moderate-certainty evidence that compression socks do not differ from regular socks. For running performance (eg, running speed mean difference [95% CI] = -0.24 [-0.79 to 0.31] and time to exhaustion standardized mean difference [95% CI] = -0.26 [-0.65 to 0.13]), pooled analysis indicated very low to low-certainty evidence that compression socks do not differ from regular socks. For perceptual outcomes (eg, perceived exertion standardized mean difference [95% CI] = 0.06 [-0.17 to 0.29] and lower limb muscle soreness standardized mean difference [95% CI] = 0.08 [-0.35 to 0.51]), pooled analysis indicated very low to moderate-certainty evidence that compression socks do not differ from regular socks.

Conclusion: There is very low to moderate-certainty evidence that wearing compression socks during running does not benefit physiological, running performance, or perceptual outcomes compared with regular socks.

Context: Those with chronic ankle instability (CAI) rely more on visual information to maintain postural control. Plantar massage and ankle joint mobilization are moderately successful at improving CAI-associated postural control impairments. Manual therapies may have a larger influence on the underlying sensory strategy used to maintain postural control, but their effect on these strategies remains unknown.

Objective: To evaluate the effects of separate 2-week plantar massage and ankle joint mobilization interventions on estimates of visual reliance during single-limb stance in those with CAI and determine whether changes in visual reliance estimates were driven by concurrent changes in peripheral- or spinal-level sensorimotor function.

Design: Randomized controlled clinical trial.

Setting: Research laboratory.

Patients: Sixty participants with CAI.

Interventions: Participants were equally randomized into plantar massage, ankle joint mobilization, and control (no intervention) groups. The manual therapy groups received six 5-minute treatments of their respective interventions over a 2-week period.

Main outcome measure: A percentage modulation outcome quantified an individual's reliance on visual information by estimating the weight given to visual information during eyes-open stance based on the magnitude of postural instability that occurs with vision removed. Secondary measures included joint position sense, plantar light-touch thresholds, and the H-reflex. Outcomes were captured before (baseline), immediately after (post), and 1-month (follow-up) after the 2-week intervention.

Results: Plantar massage resulted in significant percentage modulation changes in sagittal (P ≤ .046) but not frontal plane outcomes (P ≥ .069) relative to the control group. Joint mobilization did not alter percentage modulation changes (P ≥ .413). Significant correlations between percentage modulation changes and peripheral sensorimotor function were noted primarily at the 1-month follow-up.

Conclusions: A 2-week plantar massage but not an ankle joint mobilization intervention alters sagittal plane percentage modulation values during single-limb stance in those with CAI. These changes may be driven by changes in peripheral sensorimotor function.

Context: Chronic ankle instability (CAI) is a common consequence of a lateral ankle sprain. Sex differences in functional outcomes exist, but there is a lack of female-specific intervention studies. Hop stabilization training is effective in male athletes with CAI but has not been investigated in female athletes. Therefore, the purpose of this investigation was to describe the effect of hop stabilization exercises on functional movement patterns and patient-reported outcomes in female athletes with CAI. We also compared the current effect sizes with those observed in an all-male cohort following an identical intervention.

Design: Randomized controlled trial.

Methods: Fourteen female CAI participants completed hop stabilization training (age = 25.29 [5.86] y), and 14 female CAI participants were in the control group (age = 24.73 [6.97] y). Inclusion criteria were consistent with the International Ankle Consortium recommendations. The hop stabilization program consisted of three 20-minute sessions per week for 6 weeks. Sessions consisted of increasing foot-to-ground contacts each week until a taper in the final week. Exercise difficulty was also modified throughout the program. Functional movement patterns via the Functional Movement Screen and Fusionetics Scores, dorsiflexion range of motion, and select region-specific patient-reported outcomes were captured.

Results: The hop training group (pre: 12.68 [1.32] cm, post: 13.42 [1.35] cm) had a significant improvement (P< .001) in dorsiflexion range of motion relative to the control group (pre: 13.62 [1.22] cm, post: 13.68 [1.16] cm). Hop training also significantly improved (P,<0.01) functional movement patterns and all patient-reported outcomes. Relative to an all-male cohort who previously underwent the same hop stabilization program, the current female cohort demonstrated larger effect sizes, but all 95% CIs overlapped.

Conclusions: A 6-week hop training program significantly improves patient-reported outcomes, dorsiflexion range of motion, and functional movement patterns in female athletes with CAI .