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Alicea E. Taylor-Meza, Kelsey N. Bahe, Michael A. Trevino, Jennifer L. Volberding, and Aric J. Warren

Focused Clinical Question: What is the efficacy of dry needling (DN) compared to ischemic compression point therapy for improving pain and pain pressure threshold (PPT) in patients experiencing myofascial neck pain? Clinical Bottom Line: There is low-level evidence suggesting DN has the potential to elicit greater improvements in pain and PPT relief compared to ischemic compression techniques for individuals with myofascial neck pain.

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Oğuz K. Esentürk and Erkan Yarımkaya

The aim of this study was to evaluate the feasibility and potential efficacy of a WhatsApp-based physical activity for children with autism spectrum disorder (ASD). Fourteen parents and their children with ASD participated in the study. The intervention included parents conducting physical activities with their children with ASD for 4 weeks. Physical activity contents were provided to parents via the WhatsApp group. The data were collected through the Leisure Time Exercise Questionnaire and a feasibility questionnaire adapted from previous studies examining the feasibility of web-based physical activities. Parents reported that WhatsApp-based physical activities were a feasible intervention to increase the physical activity level of their children with ASD and stated that the contents of the physical activity shared in the WhatsApp group were useful. The findings provided preliminary evidence for the use of WhatsApp-based physical activities to increase the physical activity level of children with ASD who stay at home due to the pandemic.

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Lisa Chaba, Stéphanie Scoffier-Mériaux, Fabienne d’Arripe-Longueville, and Vanessa Lentillon-Kaestner

This article focuses on two popular sports that can put male athletes at risk of developing an eating disorder: bodybuilding and running. Bodybuilders concentrate on gaining muscle mass and runners on leaning body mass. Based on the trans-contextual model of motivation, this study aimed to better understand the psychological mechanisms underlying eating disorders in these athletes. In all, 272 male bodybuilders and 217 male runners completed measures of sport motivation, theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention to gain muscle mass/lean body mass), and eating disorders (dieting, control, and bulimia behaviors). The results revealed satisfactory fit indices for both samples. Autonomous and controlled motivations for sport were positively directly and indirectly related to eating disorders in these athletes. This motivational mechanism needs more in-depth investigation, and motivational profiles might help distinguish athletes with and without eating disorders.

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Nicole Sordello, Tenli Bright, Taylor Truesdell, Jace Puckett, Jayme G. Baker, and Russell T. Baker

Focused Clinical Question: What are the effects of Total Motion Release® on shoulder range of motion compared with stretching in overhead athletes? Clinical Bottom Line: Total Motion Release® significantly improved acute dominant and nondominant shoulder ROM compared with dynamic warm-up and stretching protocols. The application of Total Motion Release® was also found to produce significantly larger increases in shoulder ROM and took substantially less time to complete when compared with dynamic warm-up protocols.

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Melanie A. Mason, Anne C. Russ, Ryan T. Tierney, and Jamie L. Mansell

Context: Exercise can cause fluctuations in blood glucose control in type 1 diabetics. For athletes with type 1 diabetes, maintenance of blood glucose within an ideal range may be difficult.Objective: To determine, in individuals with type 1 diabetes, the effectiveness of the closed loop control system versus the open loop control system in keeping blood glucose levels in the ideal range with exercise. Data Sources: A search of PubMed was conducted in June of 2020 using the Boolean phrases: (closed loop control system OR artificial pancreas) AND type 1 diabetes AND exercise AND ideal range AND adolescents, artificial pancreas AND glucose prediction AND exercise. Study Selection : Titles were reviewed for relevance, the abstract was then assessed for applicability, and finally the full text was examined. Articles were included that examined the percent of time in the ideal blood glucose range when exercise occurred during that day. Articles were excluded that didn’t compare the closed loop and open loop control systems and articles that did not involve exercise. Data Extraction : The PEDro scale was used to determine the methodological quality of the included studies. The measure addressed was the percent of time in the ideal blood glucose range of 70-180 mg/dL. 95% Confidence Intervals and Cohen’s D were calculated for each article. Data Synthesis : The search yielded 268 articles and 3 were selected for inclusion. The two randomized controlled trials scored 9/10 on the PEDro scale and the randomized two-arm crossover clinical trial scored 9/10 on the PEDro scale. Percent time spent in the ideal blood glucose range when exercise was performed was significantly higher in the closed loop group versus the open loop group in each of the three studies. In one randomized control trial, mean time in the ideal range was 71.3% (SD = 17.6, 95% CI = 62.5, 80.10) in the closed loop group versus 64.7% (SD = 13.3, 95% CI = 58.1–71.4) in the open loop group. Cohen’s D was 0.4. In the second randomized control trial, mean time in the ideal range was 73.5% (SD = 8.4, 95% CI = 70.1, 76.9) for the closed loop group versus 50% (SD = 26.8, 95% CI = 39.1, 60.9). Cohen’s D was 1.2. The two-arm crossover clinical trial resulted in a mean time in target range of 84.1% (SD = 11.5, 95% CI = 79.0, 89.2) in the closed loop group versus 68.7% (SD = 13.9, 95% CI = 62.5, 74.9) in the open loop group. Cohen’s D was 1.2. Conclusions : For adolescents with type 1 diabetes who exercise, the closed loop control system maintains blood glucose levels in the ideal range for a longer percent of time versus an open loop system. Each patient should be evaluated on a case-by-case basis with his/her healthcare team. Future research should examine the closed loop control system on specific energy systems.

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Sierra Hakanson, Samuel T. Johnson, Emily C. Norcross, and Cathleen N. Brown

Clinical Scenario: Ulnar collateral ligament injuries are common in baseball pitchers, with excessive elbow varus torque linked to medial elbow injuries. Trunk tilt, or motion in the frontal plane, could be an identifiable and modifiable factor in medial elbow loading. Clinical Question: In high school through professional baseball pitchers, how does increased contralateral trunk tilt compared with no/limited contralateral trunk tilt influence elbow varus torque? Summary of Key Findings: Four studies were included: all were labeled as “controlled” or “descriptive laboratory studies,” representing cross-sectional observational analytic design. One study compared biomechanics of professional pitchers with and without ulnar collateral ligament reconstruction. Two studies measured biomechanics in college pitchers, one of which also included simulations of joint angles. The fourth study measured biomechanics of high school pitchers. All studies measured trunk tilt and its relationship to elbow varus torque, with 3 of the studies linking increased contralateral trunk tilt with increased elbow varus torque. Clinical Bottom Line: Moderate evidence indicated as contralateral trunk tilt increased, so did elbow varus torque, indicating trunk tilt may be a modifiable factor to decrease medial elbow loading during pitching. Strength of Recommendation: Majority consistent findings from the level 3 cross-sectional observational analytic designs suggest grade B evidence in support of trunk tilt as a factor in increasing elbow varus torque.

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Germanna M. Barbosa, Larissa P. Ribeiro, Ana B. Nasser, Gretchen D. Oliver, and Paula R. Camargo

Context: Understanding the musculoskeletal adaptations in the shoulder complex of varying ages of tennis athletes may suggest preventive protocols and conditioning and rehabilitation programs to this population. This study aimed to generate a bilateral descriptive profile of shoulder flexibility, scapular and clavicular position, and muscle strength in pediatric and adult amateur tennis athletes. The outcome measures were compared between groups and sides. The number and percentage of athletes “at risk” according to cutoff values for shoulder range of motion (ROM) were also analyzed. Design: Cross-sectional study. Methods: 36 pediatric and 28 adult amateur tennis athletes were tested. Outcome measures were ROM of shoulder flexion, abduction, internal and external rotation, posterior capsule tightness, pectoralis minor index (PMI), scapular upward rotation, clavicular elevation, and strength of the external rotators, serratus anterior, and lower trapezius of the dominant/nondominant sides. Results: Pediatric athletes had greater dominant side external rotation (P = .01) and total ROM (P = .04), increased Low Flexion test (P = .01), and decreased PMI (P = .01) compared with the adults. Bilaterally, the pediatric athletes had greater dominant side external rotation ROM (P < .01) and decreased PMI (P = .002) as compared with their nondominant side, whereas the adults displayed lower values on posterior capsule tightness (P = .01) and decreased PMI (P = .02) on their dominant side compared with their nondominant side. For the remaining outcomes, no interaction effects were observed. The cutoff values for shoulder ROM showed that several athletes were “at risk” of shoulder problems. Conclusion: Upper extremity adaptations at the shoulder are present in both pediatric and adult tennis athletes. These data can assist clinicians in better understanding the biomechanical adaptations in the shoulder of amateur tennis athletes in different age groups.

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Eric R. Levasseur, Kevin D. Dames, Mark A. Sutherlin, Alyson Dearie, and Sonya Comins

Collegiate- and elite-level swimmers can see extraordinary volumes in training throughout a season. Consequentially, injury and dysfunction in the shoulder are common in competitive swimmers. This study investigated whether preseason Kerlan-Jobe Orthopedic Clinic Questionnaire scores could identify collegiate swimmers who sustained a shoulder injury during an athletic season. A Kerlan-Jobe Orthopedic Clinic Questionnaire score of ≥81 was able to identify swimmers who did not sustain an injury versus those who did. The receiver operating characteristics demonstrated an area under the curve of 0.820, p < .004. A Kerlan-Jobe Orthopedic Clinic Questionnaire score of 81 had a sensitivity of 1.00 and specificity of 0.333. The current findings suggest that selective preseason patient-reported outcome measures could be utilized as a preparticipation screening tool to investigate athlete readiness to compete.

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Lilly H. VanDeMark, Christina B. Vander Vegt, Cassie B. Ford, Jason P. Mihalik, and Erik A. Wikstrom

Context: Prophylactic and rehabilitative balance training is needed to maximize postural control and develop appropriate sensory organization strategies. Partially occluding vision during functional exercise may promote appropriate sensory organization strategies, but little is known about the influence of partially occluded vision on postural control in those with and without a history of musculoskeletal injury. Objective: To determine the effect of increasing levels of visual occlusion on postural control in a heterogeneous sample of those with and without chronic ankle instability (CAI). The secondary objective was to explore postural control responses to increasing levels of visual occlusion among those with unilateral and bilateral CAI relative to uninjured controls. Design: Cross-sectional. Setting: Sports medicine research laboratory. Patients or Other Participants: Twenty-five participants with unilateral CAI, 10 with bilateral CAI, and 16 participants with no history of lower extremity injury. Main Outcome Measures: All participants completed four 3-minute postural control assessments in double-limb stance under the following 4 visual conditions: (1) eyes open, (2) low occlusion, (3) high occlusion, and (4) eyes closed. Low- and high-occlusion conditions were produced using stroboscopic eyewear. Postural control outcomes included time-to-boundary minima means in the anteroposterior (TTB-AP) and mediolateral directions (TTB-ML). Repeated-measures analysis of variances tested the effects of visual condition on TTB-AP and TTB-ML. Results: Postural control under the eyes-open condition was significantly better (ie, higher) than the limited visual occlusion and eyes-closed conditions (P < .001) for TTB-AP and TTB-ML. For TTB-AP only, partially occluded vision resulted in better postural control than the eyes-closed condition (P ≤ .003). Conclusions: Partial and complete visual occlusion impaired postural control during dual-limb stance in a heterogeneous sample of those with and without CAI. Stroboscopic eyewear appears to induce postural control impairments to the same extent as complete visual occlusion in the mediolateral direction.

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Kyeongtak Song, Kyle B. Kosik, Phillip A. Gribble, and Erik A. Wikstrom

Context: Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. Objective: The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. Design: Descriptive observational study. Setting: Laboratory. Patients or Other Participants: Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. Intervention: None. Main Outcome Measures: Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). Results: For T1ρ relaxation time, intraobserver (ICC = .994–.997, RMSCV = 1.31%–1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975–.980, RMSCV = 3.88%–4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. Conclusions: The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.