Physical Therapy in Sport - Articles in Press

Evaluation and management of posterior cruciate ligament injuries - Corrected Proof

Michael D. Rosenthal, Charles E. Rainey, Angela Tognoni, Robert Worms — 2012-05-21

Abstract: Background: Posterior cruciate ligament injuries are increasingly recognized, the result of various sports activities, and while most athletes return to sports the development degenerative joint changes is common.Objective: To provide a synopsis of the current best evidence regarding the recognition and treatment of posterior cruciate ligament injuries.Design: Structured narrative review.Methods: Keyword search of Medline, CINAHL, and PEDro databases for studies published in English from January 1975 to July 2011. Additionally, the reference lists from articles obtained were manually searched for relevant literature.Summary: The manuscript provides an overview of posterior cruciate ligament injury, discusses diagnostic methods to include radiographic examination techniques, and presents information on surgical and conservative management of PCL injuries.Conclusion: Understanding the mechanism of injuries and most effective examination methods can aide in effective early recognition of PCL injuries. Appropriate management of the patient with PCL deficiency or reconstructed knee will optimize outcomes and potentially affect long term knee function.

A suggested model for physical examination and conservative treatment of athletic pubalgia - Corrected Proof

Eric J. Hegedus, Ben Stern, Michael P. Reiman, Dan Tarara, Alexis A. Wright — 2012-05-10

Abstract: Background: Athletic pubalgia (AP) is a chronic debilitating syndrome that affects many athletes. As a syndrome, AP is difficult to diagnose both with clinical examination and imaging. AP is also a challenge for conservative intervention with randomized controlled trials showing mixed success rates. In other syndromes where clinical diagnosis and conservative treatment have been less than clear, a paradigm has been suggested as a framework for clinical decision making.Objectives: To propose a new clinical diagnostic and treatment paradigm for the conservative management of AP.Design: Relevant studies were viewed with regard to diagnosis and intervention and where a gap in evidence existed, clinical expertise was used to fill that gap and duly noted.Results: A new paradigm is proposed to assist with clinical diagnosis and non-surgical intervention in patients suffering with AP. The level of evidence supporting this paradigm, according to the SORT taxonomy, is primarily level 2B.Conclusions: Further testing is warranted but following the suggested paradigm should lead to a clearer diagnosis of AP and allow more meaningful research into homogeneous patient populations within the AP diagnostic cluster.Strength-of-Recommendation Taxonomy (SORT): 2B

Reliability of a novel procedure to monitor the flexibility of lower limb muscle groups in highly-trained adolescent athletes - Corrected Proof

2012-05-07

Abstract: Objectives: To evaluate the reliability level of an innovative method using a standardized stretch force to assess the flexibility of lower limb muscle groups in highly-trained adolescent athletes and to examine whether interchanging the examiners affects the reliability of the measures.Design: Randomized test–retest study.Setting and participants: In ten athletes, the flexibility of eight lower limb muscle groups was examined on two occasions on both sides and in two phases: a video capture by three distinct operators and an analysis by three distinct analysers. The reliability of the measures was assessed by the coefficient of variation (CV, 90% CI). Between-analysers and between-operators standardized differences (i.e., Cohen's d) were calculated.Results: CV (%, 90% CI) were 8.3% (7.5; 9.3) for quadriceps, 3.3% (3.0; 3.7) for hamstrings, 7.2% (6.5–8.0) for adductors, 5.7% (5.1; 6.3) for gastrocnemius, 4.5% (4.0; 5.0) for soleus, 2.6% (2.3; 2.9) for hip flexors, 9.6% (8.6; 10.8) for hip medial rotators and 12.4% (12.2; 14.0) for hip lateral rotators. There was no substantial (i.e., Cohen's d < 0.2) difference in CV between all the possible operators/analysers combinations.Conclusion: This method has a moderate-to-good reliability level and is examiner-independent. It may be implemented in future injury prevention programs, in order to monitor the flexibility of highly-trained adolescent athletes.

A comparison of electromyography of gluteus medius and maximus in subjects with and without chronic ankle instability during two functional exercises - Corrected Proof

Kathryn A. Webster, Phillip A. Gribble — 2012-05-03

Abstract: Objective: To determine how gluteus medius (Gmed) and maximus (Gmax) activate during closed-chain functional rehabilitative exercises in those with and without chronic ankle instability (CAI).Design: Cohort study. Subjects performed ten repetitions of a rotational lunge and single-leg rotational squat while surface electromyography was used to collect mean muscle activity of the Gmed and Gmax.Main outcome measures: Mean electromyography activity of the Gmed and Gmax at maximum excursion was compared between Groups and Exercises using a separate 2-way repeated measures analysis of variance design for each muscle.Setting: University biomechanics lab.Participants: Nine healthy (8F, 1M) and nine CAI subjects (8F, 1M)Results: For Gmax activation, there was a statistically significant Group by Exercise interaction (F3,48 = 4.84, p = 0.043). A Scheffe's post-hoc test revealed that during the rotational squat, the CAI group had significantly lower Gmax activation (51.1 ± 31.0%) than the healthy group (78.6 ± 44.8%). There were no statistically significant findings for the Gmed. In the healthy group, the Gmax produced significantly higher activation during rotational squat (78.6 ± 44.8%) compared to the rotational lunge (57.6 ± 31.9%).Conclusion: Because the CAI group had significantly less Gmax activation than the healthy group during the rotational squat at the point of maximum excursion, and because the rotational squat showed significantly higher Gmax activation compared to the rotational lunge, it may be important for clinicians to implement the rotational squat during rehabilitation for those with CAI. Future prospective and intervention research involving hip musculature in those with CAI is recommended.

Effects of moving forward or backward on the saddle on knee joint forces during cycling - Corrected Proof

Rodrigo Rico Bini, Patria Anne Hume, Fabio Junner Lanferdini, Marco Aurélio Vaz — 2012-04-30

Abstract: Objectives: To examine the effects of cycling at preferred, forward and backward saddle positions on patellofemoral compressive and tibiofemoral compressive and shear forces.Design: Cross-sectional.Setting: An incremental cycling test to exhaustion determined cyclists' maximal aerobic workload and second ventilatory threshold. In a second session, 1-min cycling trial at maximal aerobic workload then three 2-min trials at second ventilatory threshold workload at preferred, forward and backward saddle positions. Right pedal force via instrumented pedals, lower limb joint kinematics via video and inverse dynamics were used to calculate knee joint forces.Participants: Twenty-one competitive cyclists (28 ± 7 years).Main outcome measures: Patellofemoral compressive, tibiofemoral compressive and shear forces, and knee flexion angle.Results: Changes to forward/backward saddle positions did not substantially affect compressive forces for patellofemoral (1–4%) or tibiofemoral (1–3%) joints. Tibiofemoral shear force increased in backward compared with preferred (19%) or forward (26%) saddle positions. Knee flexion angle at 3 o'clock (22%) and 6 o'clock crank positions (36%) increased at the forward compared to the backward saddle position.Conclusions: Small increases in knee flexion angle (5–6°) explained trivial differences in patellofemoral and tibiofemoral compressive forces. Tibiofemoral shear force may be more sensitive to changes in knee joint angle compared to other knee force components.

Acute effects of cold pack on mechanical properties of the quadriceps muscle in healthy subjects - Corrected Proof

Sirpa Mustalampi, Jari Ylinen, Hannu Kautiainen, Adam Weir, Arja Häkkinen — 2012-04-25

Abstract: Purpose: To examine the effects of local cooling on mechanical properties of the quadriceps muscle in healthy subjects.Subjects: Thirty-nine healthy subjects (27 women, 12 men, mean age 39, range 20–62) volunteered.Methods: A cold gel pack was applied to the quadriceps muscle for 20 min. Properties were quantified by analyzing the frequency (tension), decrement (elasticity) and stiffness of damped oscillations and the compliance of the muscle before, immediately after and after 15-min after cooling.Results: The largest responses immediately after cooling were seen in the oscillation decrement parameter, 7.9 (3.7–12.1) %, and in the compliance parameter, −7.5 (−9.8 to −5.3) %. Responses in the oscillation frequency, 6.5 (2.3–10.6) %, and stiffness parameters, 4.0 (0.8–7.1) %, were also statistically significant. The compliance still showed a −6.1 (−7.7 to −4.5) % decrease after the 15 min recovery phase, while no remaining alteration was found in the oscillation parameters.Conclusion: The quadriceps muscle became tenser, stiffer, and less elastic as a result of cooling, and the mechanical properties were not fully recovered after 15 min. Careful warming-up is suggested after cooling to enable normalization of mechanical properties of the muscle and to avoid injuries.

Isokinetic knee function in healthy subjects with and without Kinesio taping - Corrected Proof

Oscar M.H. Wong, Roy T.H. Cheung, Raymond C.T. Li — 2012-04-16

Abstract: Objective: This study examined the difference in the isokinetic knee performance in healthy subjects with and without the Kinesio tape application onto the skin surface overlying the vastus medialis.Design: A cross-sectional experimental study.Setting: Clinical setting.Participants: 30 healthy participants.Main outcome measures: Maximal concentric knee extension and flexion at three angular velocities (60, 120 and 180°/s) were measured with an isokinetic dynamometer. Normalized peak torque, normalized total work done and time to peak torque of knee extension and flexion were compared by repeated measures ANOVA.Results: There was no significant main effect in ANOVA in normalized peak torque and normalized total work done between taping conditions and angular velocities. Conversely, participants demonstrated significant shorter time to peak extension torque with the tape condition (p = 0.03). Pair-wise comparisons indicated that such time reduction (36–101 ms) occurred at all three angular velocities (p < 0.01).Conclusion: This investigation demonstrated the application of Kinesio tape did not alter the muscle peak torque generation and total work done but shortened the time to generate peak torque. This finding may contribute to the rationale in injury prevention and rehabilitation in athletes with Kinesio taping.

Comparison of landing knee valgus angle between female basketball and football athletes: Possible implications for anterior cruciate ligament and patellofemoral joint injury rates - Corrected Proof

Allan Munro, Lee Herrington, Paul Comfort — 2012-04-12

Abstract: Objective: To evaluate landing strategies of female football and basketball athletes with relation to possible injury mechanisms and disparity in injury.Design: Descriptive laboratory study.Participants: 52 female football players and 41 female basketball players.Main outcome measures: Frontal plane projection angle (FPPA) was measured during the single leg land (SLL) and drop jump (DJ) screening tasks.Results: 2 × 2 × 2 mixed factorial ANOVA showed significant main effects were observed for sport, whilst significant interaction effects were seen between sport and task. Females in both sports exhibited significantly greater FPPA values during the SLL task than the DJ task (p < 0.001). Basketball players demonstrated significantly greater FPPA values during SLL than football players (p < 0.001), whilst no differences were found between sports in the DJ task (p = 0.328).Conclusion: Female basketball players display greater FPPA values during unilateral landing tasks than female football players which may reflect the greater ACL injury occurrence in this population. Injury prevention programs in these athletes should incorporate unilateral deceleration and landing tasks and should consider the specific injury mechanisms in each sport.

Critical reflection of the advanced rehabilitation of an elite rugby league player sustaining a posterior Bankart lesion - Corrected Proof

Andrew McDonough, Lennard Funk — 2012-04-09

Abstract: The following is a critical description and discussion of the successful assessment and rehabilitation of a right shoulder posterior Bankart repair in an elite rugby league player. The rehabilitation follows accelerated, goal based guidelines, widely adopted in current sports practice but not well documented in the literature (). The study serves to be the first critical discussion of such a regime.

Effects of a lower limb functional exercise programme aimed at minimising knee valgus angle on running kinematics in youth athletes - Corrected Proof

Kelly R. Sheerin, Patria A. Hume, Chris Whatman — 2012-04-06

Abstract: Objectives: To investigate the effectiveness of 8-weeks of lower limb functional exercises on frontal plane hip and knee angles during running in youth athletes.Design: Pre- and post-intervention quantitative experimental.Methods: Nineteen athletes (11 male, 8 female, 11.54 ± 1.34 years) from a long-term athletic development programme had 3-dimensional running gait measured pre and post an 8-week exercise intervention. Youth athletes randomised to control (upper limb strengthening exercises) or experimental (lower limb functional exercises aimed at minimising knee valgus angle) interventions completed the exercises during the first 10 min of training, three mornings a week. Pre- and post-parallel groups’ analysis provided estimates of intervention effects for control and experimental groups.Results: Differences in pre- to post-intervention changes in mean frontal plane angles between control and experimental groups were trivial for the left hip (0.1°) and right knee (−0.3°). There was a small beneficial decrease in right hip joint angle (0.4°) but a very large (ES = 0.77, CI 0.1–3.7) detrimental increase in left knee valgus angle (1.9°) between groups.Conclusion: The 8-week lower limb functional exercises had little beneficial effects on lower limb hip and knee mechanics in youth athletes aged 9–14 years.

Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors - Corrected Proof

Helen Walker, Belinda Gabbe, Henry Wajswelner, Peter Blanch, Kim Bennell — 2012-03-01

Abstract: Objective: To investigate shoulder pain incidence rates and selected risk factors for shoulder pain in competitive swimmers.Design: 12-month prospective cohort study.Setting: Five swimming clubs in Melbourne, Australia.Participants: 74 (37 M, 37 F) competitive swimmers ranging in age from 11 to 27 years and performing at least five swim sessions per week.Assessment of risk factors: Swimmers completed a baseline questionnaire regarding demographics, anthropometric features, swimming characteristics and training and injury history. Active shoulder internal (IR) and external rotation (ER) range of motion and passive joint laxity were measured.Main outcome measurements: Shoulder pain was self-reported over 12 months with significant interfering shoulder pain (SIP) defined as pain interfering (causing cessation or modification) with training or competition, or progression in training. A significant shoulder injury (SSI) was any SIP episode lasting for at least 2 weeks.Results: 28/74 (38%) participants reported SIP while 17/74 (23%) reported SSI. Exposure-adjusted incidence rates were 0.3 injuries and 0.2 injuries per 1000 swim km for SIP and SSI, respectively. Swimmers with both high and low ER range were at 8.1 (1.5, 42.0) and 12.5 (2.5, 62.4) times greater risk of sustaining a subsequent SIP, respectively and 35.4 (2.8, 441.4) and 32.5 (2.7, 389.6) times greater risk of sustaining a SSI, respectively than those with mid-range ER. Similarly swimmers with a history of shoulder pain were 4.1 (95% CI: 1.3, 13.3) and 11.3 (95% CI: 2.6, 48. 4) times more likely to sustain a SIP and SSI, respectively.Conclusion: Shoulder pain is common in competitive swimmers. Preventative programs should be particularly directed at those swimmers identified as being at risk of shoulder pain.

Asymmetry in multi-directional jumping tasks - Corrected Proof

Jennifer K. Hewit, John B. Cronin, Patria A. Hume — 2012-02-20

Abstract: Objectives: Quantify and compare average symmetry indexes (ASI) across jumping directions (vertical, lateral and horizontal) and variables (jump distance and height, peak force and peak power) in a non-injured population of netball players.Methods: Nineteen sub-elite netball players (age: 19.5 ± 1.1 years, body mass: 75.1 ± 11.8 kg, height: 177.6 ± 5.2 cm) performed three single-leg countermovement jumps from a force plate in the vertical, horizontal and lateral directions. Force, power and jump height ASI’s were calculated from force plate data. Jump distance ASI was calculated as the distance jumped.Results: Individual ASI’s ranged from 0.0 to 48.6% while averaged ASI’s ranged from 3.1% (peak force) to 11.4% (peak power). Significant (p ≤ 0.05) ASI differences were observed between vertical force (3.0%) and power (9.2%) (p = 0.02), horizontal power (11.4%) and jump distance (4.6%) (p < 0.001), horizontal force (8.0%) and distance (4.6%) (p < 0.001) and lateral power (10.0%) and jump distance (6.2%) (p = 0.05). The greatest ASI was found for the lateral direction (8.4 ± 1.2% averaged across the three variables).Conclusions: There appears to be some variation in the magnitude of the ASI depending on the variable and direction used to quantify the asymmetry. Decisions need to be made by the strength and conditioning practitioner as to which variables and directions are specific to the requirements of their sport, position or activity.

Reliability, precision, and gender differences in knee internal/external rotation proprioception measurements - Corrected Proof

Takashi Nagai, Timothy C. Sell, John P. Abt, Scott M. Lephart — 2012-02-10

Abstract: Objective: To develop and assess the reliability and precision of knee internal/external rotation (IR/ER) threshold to detect passive motion (TTDPM) and determine if gender differences exist.Design: Test–retest for the reliability/precision and cross-sectional for gender comparisons.Setting: University neuromuscular and human performance research laboratory.Participants: Ten subjects for the reliability and precision aim. Twenty subjects (10 males and 10 females) for gender comparisons.Intervention: All TTDPM tests were performed using a multi-mode dynamometer. Subjects performed TTDPM at two knee positions (near IR or ER end-range). Intraclass correlation coefficient (ICC (3,k)) and standard error of measurement (SEM) were used to evaluate the reliability and precision. Independent t-tests were used to compare genders.Main outcome measurements: TTDPM toward IR and ER at two knee positions.Results: Intrasession and intersession reliability and precision were good (ICC=0.68–0.86; SEM=0.22°–0.37°). Females had significantly diminished TTDPM toward IR at IR-test position (males: 0.77°±0.14°, females: 1.18°±0.46°, p=0.021) and TTDPM toward IR at the ER-test position (males: 0.87°±0.13°, females: 1.36°±0.58°, p=0.026). No other significant gender differences were found (p>0.05).Conclusions: The current IR/ER TTDPM methods are reliable and accurate for the test–retest or cross-section research design. Gender differences were found toward IR where the ACL acts as the secondary restraint.

Comparison of electromyographic activity of the lower trapezius and serratus anterior muscle in different arm-lifting scapular posterior tilt exercises - Corrected Proof

2012-01-30

Abstract: Objective: To determine the most effective exercise to specifically activate the scapular posterior tilting muscles by comparing muscle activity generated by different exercises (wall facing arm lift, prone arm lift, backward rocking arm lift, backward rocking diagonal arm lift).Design: Repeated-measure within-subject intervention.Participants: The subjects were 20 healthy young men and women.Main outcome measures: Lower trapezius (LT) and serratus anterior (SA) muscle activity was measured when subjects performed the four exercises.Results: Muscle activity was significantly different among the four exercise positions (p<0.05). The backward rocking diagonal arm lift elicited significantly greater activity in the LT muscle than did the other exercises (p<0.05). The backward rocking arm lift showed significantly more activity in the SA muscle than did the other exercises (p<0.05).Conclusions: Clinicians can use these results to develop scapular posterior tilting exercises that specifically activate the target muscle.

Reproducibility and criterion-related validity of the sit and reach test and toe touch test for estimating hamstring flexibility in recreationally active young adults - Corrected Proof

F. Ayala, P. Sainz de Baranda, M. De Ste Croix, F. Santonja — 2012-01-24

Abstract: Objective: 1) to examine the test-retest reproducibility and criterion-related validity of the sit and reach test (SRT) and the toe touch test (TT) for estimating hamstring flexibility measured through the passive straight leg raise test (PSLR); and 2) to determine whether the SRT cut-off scores may be used for the TT test to identify participants in this sample of young healthy adults as having short hamstring flexibility.Design: Test-retest design.Setting: Controlled laboratory environment.Participants: 243 active recreationally young adults.Main outcome measures: Participants performed the SRT, the TT test and PSLR twice in a randomized order with a 4-week interval between trials. Reproducibility was examined using typical percentage error (coefficient of variation [CV]) and intraclass correlation coefficient (ICC) as well as their respective confidence limits. Regression and Kappa correlation statistical analyses were performed to study the association of the SRT and TT test with the PSLR test and the 95% limits of agreement (LoA) between SRT and TT test were calculated to explore differences in the mean differences between these measurements.Results: The finding showed acceptable reproducibility measures for SRT (8.74% CV; 0.92 ICC), TT test (9.86% CV; 0.89 ICC) and PSLR (5.46% CV; 0.85 ICC). The SRT (R2 = 0.63) and TT test (R2 = 0.49) were significantly associated with PSLR. The 95% LoA between SRT and TT test reported systematic bias (2.84 cm) and wide 95% random error (±9.72 cm).Conclusions: Reproducibility of SRT, TT test and PSLR is acceptable and the criterion-related validity of SRT and TT test is moderate. Furthermore, the SRT cut-off scores should not be used for TT test for the detection of short hamstring muscles.

The effect of foot orthotic use on exercise related leg pain in cross country athletes - Corrected Proof

Mark F. Reinking, Ann M. Hayes, Tricia M. Austin — 2012-01-16

Abstract: Objectives: The purposes of this research were to (1) investigate the effect of foot orthotic use on exercise related leg pain (ERLP) in cross-country (XC) athletes, and (2) determine if an association between foot type and foot orthotic use exists.Design: Prospective cohort design.Setting: High schools and colleges in a Midwestern metropolitan region.Participants: 213 high school and college XC athletes (107 male, 106 female).Materials/Methods: Participants were seen before the fall XC season for classification of foot type, visual orthotic inspection, and questionnaire completion regarding foot orthotic use and ERLP. Statistical analysis of relationships (chi-square) was conducted.Results: 37 of the 213 XC athletes (17.4%) used foot orthotics; 31 of the 37 athletes using foot orthotics (83.8%) reported a history of ERLP. Of these 31 athletes, 17 (54.8%) were using orthotics for ERLP and 15 reported a decrease in ERLP with orthotic use. Fourteen athletes were using orthotics for a reason other than ERLP and only 2 reported a decrease in ERLP with orthotic use. Athletes using orthotics included all three foot types (pronated, neutral, supinated) with no relationship between orthotic use and foot type.Conclusion: One-sixth of the XC athletes used foot orthotics and most using orthotics for ERLP reported a decrease in ERLP symptoms. The majority of athletes using orthotics for reasons other than ERLP reported no change in ERLP symptoms. There was no association between foot type and orthotic use.

The effect of heat applied with stretch to increase range of motion: A systematic review - Corrected Proof

Jiro Nakano, Cristiane Yamabayashi, Alex Scott, W. Darlene Reid — 2011-12-30

Abstract: Application of heat to muscle is commonly advocated to enhance the efficacy of stretching. However, the effect of this combined therapy using different methods of heating, applied to different muscles, and after one or multiple treatments, is not known.To perform a systematic review to address the question: Does stretching augmented by heat application result in greater gains in range of motion (ROM) compared to stretch alone?The following databases were searched for original articles that evaluated our question: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, SPORTDiscus and PEDro databases. After title and abstract screening followed by full-text screening, the quality of included articles was assessed and their data was abstracted. Screening, data abstraction and quality assessment was performed and consensus was achieved by two reviewers. Range of motion (ROM) data were synthesized by meta-analyses for overall effect and subgroup analysis according to muscle group, method of heat application, single or multiple treatments, and reported tightness of muscle. Twelve studies were included and reported the effects of stretch with or without heat on ROM of 352 participants. Heat applications included ultrasound, shortwave diathermy and hot packs. Meta-analyses and subgroup analyses demonstrated greater increases in ROM after heat and stretch (H + S) than heat alone. Subgroup analysis of muscle groups and the method of heat application showed some trends, but no significant differences. Multiple treatments (more so than single treatments) showed consistent treatment effects of H + S versus stretch alone amongst subgroups. Muscles described as tight did not show a greater treatment effect in response to H + S compared to muscles not reported as tight.Heating provides an added benefit on stretch related gains of ROM in healthy people.

A neuroscience approach to managing athletes with low back pain - Corrected Proof

Emilio J. Puentedura, Adriaan Louw — 2011-12-29

Abstract: Low back pain (LBP) is a common complaint within the athletic population and is commonly managed through a biomedical approach. The injured or damaged structure causing the LBP is identified and treated, and complete recovery from the episode is expected. Clinical experience shows us that often, athletes with LBP will not recover from their episode and may continue their sports participation despite persistent pain, or they may limit participation. Recent neuroscience research into the biology of pain suggests that clinicians involved in the management of athletes with LBP should embrace a biopsychosocial approach by engaging the brain and nervous system. This manuscript provides an overview of such a biopsychosocial approach, and presents information on the neurobiology of the athlete's pain experience.

The understanding of the concept of ‘rest’ in the management of a sports concussion by physical therapy students: A descriptive study - Corrected Proof

2011-12-21

Abstract: Objectives: To investigate physical therapy students’ understanding of the concept of rest following a sport concussion and to ascertain if this understanding changes following a lecture based on current best practice concussion knowledge.Design: Pre-post observational survey.Setting: University classroom setting.Participants: A cohort of 118 (40 male, 78 female) physical therapy students participating in volunteer sports medic training.Results: Participants provided 320 (pre) and 350 (post) responses depicting activities which should be restricted following a concussion. The responses were classified into three rest-related categories: ‘Physical rest’, ‘Cognitive rest’ and ‘Mixed’ (a combination of physical and cognitive rest). Pre-lecture, approximately 74% of the student’s responses were categorized as Physical rest, and 25% under Mixed. There was a shift in the response pattern post-lecture, with 96% of the responses falling in the Mixed category.Conclusions: The results of the study highlight a lack of understanding of the concept of cognitive rest in concussion management among trainee sport medics. The need for wider dissemination of this concept as recommended by the recent consensus statement on sports concussion is indicated.

Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle - Corrected Proof

Jung-hoon Lee, Won-gyu Yoo — 2011-12-09

Abstract: Objective: Kinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle.Design: Case report.Case description: The patien was a 20-year-old female amateur swimmer with a Cobb’s angle (L1–S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9h each time).Results: The patient’s radiographs showed that the Cobb’s angle (L1–S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink.Conclusions: The case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

Asymmetry of the ULNT1 elbow extension range-of-motion in a healthy population: Consequences for clinical practice and research - Corrected Proof

2011-10-28

Abstract: Objectives: To investigate the effect of isolated muscular variance, side and hand dominance on elbow-extension range-of-motion (EE-ROM) of the median nerve upper limb neurodynamic test (ULNT1). This study analyzes these variables potential to influence ULNT1 EE-ROM symmetry and the possible consequences for clinical practice and research.Study design: Controlled laboratory study, cross-sectional.Background: No normative data exist to interpret correctly EE-ROM. Clinical interpretation is based on bilateral comparison. This procedure assumes natural EE-ROM symmetry, with lack of scientific evidence.Methods: Nineteen participants with Langer’s axillary arch (LAA), a muscular variant bridging the brachial plexus, were selected from 640 healthy volunteers, together with a matched control group. ULNT1 EE-ROM’s were measured using the Vicon® optoelectronic system.Results: A full mixed model revealed no significant effects on EE-ROM for LAA and the variable side. Significant differences were found in EE-ROM between dominant and non-dominant sides (standard ULNT1 test position: 2.84° ± 1.60°, p = 0.0004; ULNT1 with differentiating maneuver: 3.05° ± 1.98°, p = 0.003). Approximately 30% of the subjects showed clinically detectable restriction (≥10°) of the dominant side EE-ROM.Conclusion: Hand dominance is significantly associated with restriction of EE-ROM, which results in a clinically detectable asymmetry. This compromises the clinical procedure of comparing the patient’s EE-ROM to the opposite side. Erroneous conclusions could result in side to side analyses, if the effect is not taken into account in neurodynamic research.

Reproducibility of isokinetic knee eccentric and concentric strength indices in asymptomatic young adults - Corrected Proof

2011-10-24

Abstract: Objective: To assess the reproducibility of isokinetic eccentric and concentric knee extension and flexion strength indices obtained at two different angular velocities.Design: Cohort study.Setting: University human performance laboratory.Participants: 45 healthy physically active young adults (25 males).Main outcome measures: A non reciprocal protocol of concentric and eccentric contractions of the knee extensors and flexors was performed at 30 and 120°/s. Strength indices evaluated included peak moment; dynamic control ratios; and the difference between eccentric and concentric ratio at the two angular velocities.Results: No evidence for inter-test bias in any of the strength indices was noted. Measurement precision for peak moment, as quantified using ratio limits of agreement, suggest that scores may be expected to vary up to 15% for the knee extensors in both eccentric and concentric contraction modes. An error of up to 19% was calculated for the peak moment scores of the knee flexors. Intraclass correlation coefficients revealed fairly robust preservation of participants’ rank order for the majority of strength indices (>0.85).Conclusion: Isokinetic-related indices of knee muscles performance enable an acceptable level of detection of expected changes in muscular strength parameters as a result of planned interventions.

EMG of the hip adductor muscles in six clinical examination tests - Corrected Proof

Gregory A. Lovell, Peter D. Blanch, Christopher J. Barnes — 2011-10-05

Abstract: Objectives: To assess activation of muscles of hip adduction using EMG and force analysis during standard clinical tests, and compare athletes with and without a prior history of groin pain.Study design: Controlled laboratory study.Participants: 21 male athletes from an elite junior soccer program.Main outcome measures: Bilateral surface EMG recordings of the adductor magnus, adductor longus, gracilis and pectineus as well as a unilateral fine-wire EMG of the pectineus were made during isometric holds in six clinical examination tests. A load cell was used to measure force data.Results: Test type was a significant factor in the EMG output for all four muscles (all muscles p < 0.01). EMG activation was highest in Hips 0 or Hips 45 for adductor magnus, adductor longus and gracilis. EMG activation for pectineus was highest in Hips 90. Injury history was a significant factor in the EMG output for the adductor longus (p < 0.05), pectineus (p < 0.01) and gracilis (p < 0.01) but not adductor magnus. For force data, clinical test type was a significant factor (p < 0.01) with Hips 0 being significantly stronger than Hips 45, Hips 90 and Side lay. BMI (body mass index) was a significant factor (p < 0.01) for producing a higher force. All other factors had no significant effect on the force outputs.Conclusions: Hip adduction strength assessment is best measured at hips 0 (which produced most force) or 45° flexion (which generally gave the highest EMG output). Muscle EMG varied significantly with clinical test position. Athletes with previous groin injury had a significant fall in some EMG outputs.

Running injuries and associated factors in participants of ING Taipei Marathon - Corrected Proof

Wei-Ling Chang, Yi-Fen Shih, Wen-Yin Chen — 2011-09-21

Abstract: Objectives: To investigate the distribution of lower extremity running injuries and their associated factors.Design: Descriptive and exploratory study.Participants: 1004 participants of the 2005 ING Taipei International Marathon.Main outcome measures: We used a self-developed questionnaire to collect data of previous running injuries and applied multivariate logistic regression modeling to examine relationships between these injuries and associated factors.Results: Of the 893 valid questionnaires, 396 (44.4%) reported having previous lower extremity pain related to running. Knee joint pain was the most common problem (32.5%). Hip pain was associated with the racing group, training duration, and medial arch support. Use of knee orthotics (P = 0.002) and ankle braces (P = 0.007) was related to a higher rate of knee and ankle pain. Participants of the full marathon group who practiced on a synthetic track had a higher incidence of ankle pain. A training duration of >60 min was linked to an increased rate of foot pain (P = 0.003).Conclusion: Our data indicated that running injuries were associated with training duration and use of orthotics. Clinicians can use this information in treating or preventing running associated injuries and pain.

Postural stability decreases in elite young soccer players after a competitive soccer match - Corrected Proof

2011-09-19

Abstract: Objective: To investigate the effects of an official soccer match on postural stability in youth elite soccer players.Design: Single-group pre-post design.Setting: Competitive soccer match.Participants: Twenty elite U-19 male soccer players (mean age: 17.7 ± 1.0 years) of which 11 completed the full experimental set-up.Main outcome measures: Postural stability evaluated by unilateral stance tests for dominant and non-dominant lower limbs on a force plate under two visual conditions: eyes opened (EO) and eyes closed (EC).Results: After the match, the centre of gravity (CoG) sway velocity with EO increased on the dominant and non-dominant limbs (median [interquartile range], 0.90°/s [0.60–1.10] vs. 1.10°/s [0.60–1.60]; and 0.70°/s [0.50–0.90] vs 1.00°/s [0.70–1.30]; respectively; p < 0.05). The CoG sway velocity with eyes closed did not change pre- to post-match.Conclusions: The soccer match decreased the postural stability only when the assessment was conducted with eyes open.

Achilles tendon tear following shock wave therapy for calcific tendinopathy of the Achilles tendon: A case report - Corrected Proof

Tsung-Ching Lin, Cheng-Yuan Lin, Cheng-Liang Chou, Cheng-Ming Chiu — 2011-09-19

Abstract: Introduction: Extracorporeal shock wave therapy (ESWT) is becoming a popular method for the treatment of musculoskeletal disorders. We herein report a case of Achilles tendon rupture possibly related to ESWT.Case report: A 49-year-old female was treated with a calcaneal osteotomy due to Haglund’s disease on the right. However, she developed chronic calcific Achilles tendinopathy postoperatively, and during the following 2 year period after surgery she received various non-steroidal anti-inflammatory drugs and one injection of corticosteroids. She was subsequently treated with extracorporeal shock wave therapy (ESWT), but persistent pain, local swelling and redness over posterior right ankle were noted. Two months after ESWT she experienced an Achilles tendon tear and received Achilles tendon reconstruction.Conclusion: While ESWT is generally considered safe, physicians should be aware of potential major complications.

Electromyographic analysis of an eccentric calf muscle exercise in persons with and without Achilles tendinopathy - Corrected Proof

2011-09-19

Abstract: Objectives: To compare surface electromyographic (EMG) activity of the gastrocnemius and soleus muscles between persons with and without Achilles tendinopathy (AT) during an eccentric muscle exercise in different knee joint positions.Design: Repeated measures design.Setting: Research laboratory.Participants: Participants (n = 18) diagnosed with AT and 18 control subjects were recruited.Main outcome measures: Gastrocnemius and soleus muscle activity was examined by surface (EMG) during extended and flexed knee joint conditions while performing the eccentric training technique. The EMG data were expressed as a percentage of a maximum voluntary contraction (MVC).Results: EMG activity was notably higher (mean difference: 10%, effect size: 0.59) in those subjects with AT. Irrespective of the presence of AT, there was a significant interaction effect between muscle and joint position. The gastrocnemius muscle was significantly more active in the extended knee condition and soleus muscle activity was unchanged across joint positions.Conclusions: The results indicated that the presence of AT influenced calf muscle activity levels during performance of the eccentric exercise. There were differences in muscle activity during the extended and flexed knee conditions. This result does support performing eccentric exercise in an extended knee position but the specific effects of the knee flexed position on the Achilles tendon during eccentric exercise have yet to be determined, particularly in those with AT.

Taekwondo training improves the neuromotor excitability and reaction of large and small muscles - Corrected Proof

Polly Chung, Gabriel Ng — 2011-08-29

Abstract: Objectives: This study measured the neuromotor excitability and reaction time in professional and amateur Taekwondo (TKD) practitioners and compared them with non-athletes.Design: A cross-sectional cohort study design.Setting: Exercise laboratory setting.Participants: 40 TKD practitioners (20 professionals, 20 amateurs) and 20 non-athletes.Main outcome measures: Neuromotor excitability (rheobase), premotor reaction time (PRT), total reaction time (TRT) and electromechanical delay (EMD) of rectus femoris (RF) and flexor pollicis brevis (FPB) in response to audio and visual stimuli were measured. The professional TKD practitioners have shorter TRT than non-athletes with sport-specific visual stimuli but they have longer PRT and TRT in response to audio stimuli than the amateur practitioners and non-athletes.Results: The professional practitioners have longer EMD than the amateurs in responding to audio (p = 0.032) and sports-specific visual stimuli (p = 0.03) in FPB. Professional practitioners have higher excitability in RF (p < 0.001) than the amateurs and non-athletes.Conclusion: We conclude that professional TKD practitioners have better neuromotor ability in both large and small muscles with faster reactions to sport-specific stimuli, suggesting a generalized training effect across muscles. They react slower to non-sport specific stimuli, which suggested a decreased sensitivity to irrelevant sensory inputs after intensive TKD training.