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Jared Patus

Clinical Scenario: Traditional loading (TL) is a common technique to employ when engaging in countermovement jumps (CMJ). Accentuated eccentric loading (AEL) is a newer modality that is being explored for acute CMJ performance. Focused Clinical Question: In adult, resistance-trained males, will AEL have a superior impact on acute CMJ performance compared to TL? Summary of Key Findings: The literature was searched for studies that examined the influence of AEL on acute CMJ performance compared to a TL protocol. TL was defined as any loading condition that utilized an equivalent resistance during both the eccentric and concentric contractions. Three studies met the inclusion and exclusion criteria, and were identified and included in the critically appraised topic. Each of the 3 studies found that various AEL conditions were either equal to or better than TL when examining subsequent CMJ performance. In no specific CMJ outcome measure was TL deemed to have a greater impact than AEL. Clinical Bottom Line: AEL provides more favorable acute CMJ performance than TL in adult, resistance-trained males. Strength of Recommendation: Consistent findings from 2 randomized crossover studies and one repeated-measured design investigation suggest level 2b evidence to support AEL as an ideal protocol for acute CMJ performance.

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Hamid Reza Bokaeian, Fateme Esfandiarpour, Shahla Zahednejad, Hossein Kouhzad Mohammadi, and Farzam Farahmand

In this study, the effects of an exercise therapy comprising yoga exercises and medial-thrust gait (YogaMT) on lower-extremity kinetics, pain, and function in patients with medial knee osteoarthritis were investigated. Fifty-nine patients were randomly allocated to three treatment groups: (a) the YogaMT group practiced yoga exercises and medial thrust gait, (b) the knee-strengthening group performed quadriceps- and hamstring-strengthening exercises, and (c) the treadmill walking group practiced normal treadmill walking in 12 supervised sessions. The adduction and flexion moments of the hip, knee, and ankle; pain intensity; and 2-min walking test were assessed before and after treatment and at 1-month follow-up. The YogaMT group experienced a significant reduction in knee adduction moment. All groups showed significant improvement in pain and function. The YogaMT may reduce medial knee load in patients with knee osteoarthritis in the short term. A larger clinical trial is required to investigate the long-term outcomes of this intervention.

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Otávio Luis Piva da Cunha Furtado, Mikko Häyrinen, Isabela dos Santos Alves, Leonardo Travitzki, and Márcio Pereira Morato

The authors’ purpose was to examine the factors associated with penalty outcomes of male elite goalball. A total of 122 video-recorded matches from two Paralympic Games (i.e., 2012 and 2016) and the 2014 Goalball World Championship were assessed using notational analysis. Individual (n = 2), situational (n = 4), and performance variables (n = 7) were analyzed with good strength of agreement for intra- and interrater kappa index values. Their results showed that penalties play a very important role in the final score, composing around 25% of total goals in elite goalball matches. Winners were awarded on average with 62% of penalties and had 66% effectiveness compared with losers (31% and 53%) or drawers (8% and 52%). Based on the authors’ findings, penalty takers should direct their throws at specific target sectors on the court, which could increase their rate of success to over 80%.

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Sakiko Oyama, Edgar Garza, and Kylie Dugan

Context: The trunk/pelvis is an important link between the upper- and lower-extremities. Therefore, assessing strength of the trunk and hip muscles that control the segments is clinically meaningful. While an isokinetic dynamometer can be used to measure trunk strength, the equipment is expensive and not portable. Objective: To test the reliability of simple trunk and hip strength measures that utilize a bar, straps, and a portable tension dynamometer. Design: Test–retest reliability study. Setting: Biomechanics research laboratory. Patients (or Other Participants): Twenty college-age individuals (10 males/10 females, age = 20.9 [3.7] y) participated. Intervention(s): The participants attended 2 testing sessions, 1 week apart. The participants’ trunk-flexion, rotation, and hip abduction strength were measured at each session. Main Outcome Measures: Peak trunk flexion, rotation, and hip abduction forces were normalized to the participant’s body weight (BW). In addition, hip-abduction torque was calculated by multiplying the force times the leg length and normalized to BW. The trial data from both sessions were used to calculate the intrasession reliability, and the averages from the 2 sessions were used to calculate the intersession reliability. Intraclass correlation coefficients, SEM, and minimal detectable change were calculated to evaluate reliability of measures. Results: The intrasession intraclass correlation coefficients (SEM) for trunk flexion, rotation, hip abduction, and hip abduction torque were .837 (5.2% BW), .978 (1.3% BW), .955 (1.0% BW), and .969 (5.8 N·m/BW), respectively. The intersession reliability for trunk flexion, rotation, hip abduction, and hip abduction torque were .871 (4.3% BW), .801 (3.8% BW), .894 (1.5% BW), and .968 (5.9 N·m/BW), respectively. Conclusions: The measures of trunk and hip abduction strength are highly repeatable within a session. The reliability of the measures between sessions was also good/excellent with relatively small SEM and minimal detectable change. The tests described in this study can be used to assess changes in trunk/hip strength over time.

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Joanna M. Auger and Nancy L.I. Spencer

Justifications for access to physical activity for people who experience disability tend to focus on the health benefits associated with a medical model of disability. The result is often programs that are segregated and impairment-focused, with limited access to integrated settings that are also potentially inclusive. In this instrumental case study, the authors engaged 20 participants with and without impairment from an adult integrated indoor cycling program to explore what contributed to meaningful and inclusive experiences in this setting. Data were generated through semistructured interviews and reflective notes. Thematic analysis led to three themes: (a) “just going to a spin class” (b) “seamless”? and (c) “deliberate community.” Using a relational ethics framework, the findings are discussed with regard to their potential to inform the development of integrated and inclusive physical activity programs, with emphasis on program structure and instructor reflexivity and training.

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Craig R. Denegar and Justina Gray

Proprioceptive neuromuscular facilitation (PNF) stretching of the hamstrings improves flexibility but requires assistance from a clinician or partner. The original intent of our work was to assess the efficacy of self-assisted PNF hamstring stretching using a commercially available device. The authors observed improved flexibility in the stretched leg and, to a lesser extent, in the contralateral leg. While this was at first simply interesting, the finding became clinically relevant in the subsequent application in the care of a patient with low-back pain with radiating pain. This report provides study data and describes the translation of study findings into the care of a patient in a clinical setting.

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Tomonari Takeshita, Hiroaki Noro, Keiichiro Hata, Taira Yoshida, Tetsuo Fukunaga, and Toshio Yanagiya

The present study aimed to clarify the effect of the foot strike pattern on muscle–tendon behavior and kinetics of the gastrocnemius medialis during treadmill running. Seven male participants ran with 2 different foot strike patterns (forefoot strike [FFS] and rearfoot strike [RFS]), with a step frequency of 2.50 Hz and at a speed of 2.38 m/s for 45 seconds on a treadmill with an instrumented force platform. The fascicle behavior of gastrocnemius medialis was captured using a B-mode ultrasound system with a sampling rate of 75 Hz, and the mechanical work done and power exerted by the fascicle and tendon were calculated. At the initial contact, the fascicle length was significantly shorter in the FFS than in the RFS (P = .001). However, the fascicular velocity did not differ between strike patterns. Higher tendon stretch and recoil were observed in the FFS (P < .001 and P = .017, respectively) compared with the RFS. The fascicle in the positive phase performed the same mechanical work in both the FFS and RFS; however, the fascicle in the negative phase performed significantly greater work in the FFS than in the RFS (P = .001). RFS may be advantageous for requiring less muscular work and elastic energy in the series elastic element compared with the FFS.

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Irfan A. Khan and Kelley Henderson

Focused Clinical Question: What is the efficacy of structured foam rolling protocols at increasing hamstring muscle flexibility in active adults when compared with just maintaining regular levels of activity? Clinical Bottom Line: There is significant evidence to support the use of structured foam rolling programs in active adults to improve hamstring flexibility.

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Kelly Cheever and Melissa Kay

Context: Despite evidence implicating cervicogenic symptoms in the development of persistent postconcussion symptoms, factors that influence utilization of cervical clinical tests to identify cervicogenic symptoms following concussion are poorly understood. Objective: Explore barriers to the utilization of cervical clinical testing in multifaceted concussion evaluation. Design: Cross-sectional. Setting: Online survey. Patients or Other Participants: A total of 122 athletic trainers (AT) (age = 42.6 [6.4] y; female = 51.6%; 52% >10 y of clinical practice; 68% master’s degree or greater; 35% treated a minimum of 15 concussions/y). Main Outcome Measure(s): Perceived importance, clinical experience, number of concussions treated, utilization of cervical clinical tests following nonspecific cervical pathology and following concussion, comfort with cervical treatment modalities following a concussion, and recommendation for cervical-specific therapy to treat persistent postconcussion symptoms. Results: Ordinal logistic regression revealed perceived importance had the strongest positive impact on AT’s likelihood of high utilization of cervical clinical testing following concussion (95% CI, .17 to .99; P = .005), while clinical experience (95% CI, −.43 to .29; P = .71) and number of concussions treated/y (95% CI, −.21 to .31; P = .71) had no bearing. Moreover, low comfort with cervical treatments following a concussion (95% CI, −2.86 to −.26; P = .018) and low utilization of cervical clinical testing following nonspecific cervical pathology (95% CI, −7.01 to −3.39; P ≤ .001) had a strong positive impact on high utilization of cervical clinical testing following concussion. Two logistic regression models demonstrated how recommendations for cervical-specific therapy in persistent post-concussion symptom patients could be predicted based on (1) cervical test utilization and (2) perceptions and clinical experience with 79% and 78%, respectively. Conclusions: Perceived importance played a major role in utilization of cervical clinical test following concussion. ATs who utilized common cervical treatments when dealing with non-concussive injuries were more likely to utilize those same treatments to treat comorbid cervical pathology following a concussion.

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Katherine L. Helly, Katherine A. Bain, Matthew C. Hoch, Nicholas R. Heebner, Phillip A. Gribble, Masafumi Terada, and Kyle B. Kosik

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P = .030), and higher TTB anterior–posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.