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Comparison of the Effects of Isometric Horizontal Abduction on Shoulder Muscle Activity During Wall Push-Up Plus and Wall Slide in Individuals With Scapular Winging

Seok-Hyun Kim, Heon-Seock Cynn, Chung-Hwi Yi, Ji-Hyun Lee, and Seung-Min Baik

Context: Wall push-up plus (WPP) and wall slide (WS) are commonly prescribed in early rehabilitation to increase serratus anterior (SA) muscle activity. For individuals with scapular winging (SW), synergistic muscles such as upper trapezius (UT) and pectoralis major (PM) may compensate for weak SA during scapular movement. However, no studies have applied isometric horizontal abduction (IHA) during WS in individuals with SW nor have compared it with WPP with IHA. Objectives: This study compared the effects of IHA on shoulder muscle activity during WPP and WS exercises in individuals with SW. Design: Cross-sectional study; 2-way repeated-measures analysis of variance was used to assess the statistical significance of observed differences in SA, UT, PM, lower trapezius (LT), and infraspinatus (IS) muscle activities. Setting: Research laboratory. Patients: We recruited 30 individuals with SW comprising 20 men and 10 women. Interventions: The individuals performed WPP and WS exercises with and without IHA using Thera-Band. Main Outcome Measures: Surface electromyography was used to measure muscle activity of the SA, UT, PM, LT, and IS during the isometric phase of WPP and WS. Maximal voluntary isometric contractions were recorded to normalize electromyographic data. Results: There was no significant interaction between IHA application and exercise type for any of the shoulder muscles. IHA application increased SA (P = .008), UT (P = .001), LT (P = .009), and IS (P = .000) activities and decreased PM (P = .001) activity compared with those without IHA. WS exercises elicited higher PM (P = .017) and LT (P = .011) activities than WPP. Conclusion: WPP and WS with IHA may be effective in increasing the muscle activities of shoulder stabilizers and preventing overactivation of PM activity. WPP may be recommended for individuals with overactivated PM, whereas WS may be used to increase LT activity.

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Cross-Cultural Translation and Adaptation of the Perceived Recovery Status Scale to Brazilian Portuguese

Rodrigo Rodrigues Gomes Costa, Matt Laurent, Frederico Ribeiro Neto, Luis Felipe Castelli Correa de Campos, and Ciro Winckler

Context: One of the primary training variables, although often overlooked, is recovery level achieved before starting subsequent training sessions. To find a more practical measurement that is consonant with the daily training routine, the Perceived Recovery Status (PRS) scale is proposed. In this perspective, the present study aimed to translate and culturally adapt the PRS scale into Brazilian Portuguese. Design: This was a clinical measurement. Methods: The cross-cultural translation was performed according to guidelines. Linguistic validation consisted of 5 stages: forward translation, translation synthesis, back translation, analysis of inconsistencies, and cognitive debriefing. Results: During forward translation, different interpretations were obtained from the 2 translators (versions V1 and V2). Supported by an expert committee, a combined version (V3) was obtained from V1 and V2. During back translation, different interpretations were obtained from the 2 translators (versions V4 and V5). Discrepancies, applicability, and cultural equivalence were documented and analyzed by the expert committee participating in the cross-cultural translation procedure. During the cognitive debriefing, a group of 5 Brazilian people from the general population were asked to participate in a cognitive debriefing to assess the comprehensibility of the translated items. Conclusions: The PRS was translated and culturally adapted to Brazilian Portuguese (PRS-Brasil).

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Horseback Riding-Related Injuries in Portugal and Prevention Strategies

Luísa V. Pinto, Filipa C. Gouveia, Joana F. Ramalho, Sara R. Silva, and Joana R. Silva

Context: Horse riding (HR) has gain popularity in Portugal, thereby increasing the number of related injuries. This study identifies frequently occurring injuries in Portuguese riders, the conditions under which they occur, and preventive measures. Design: A retrospective cohort study. Methods: We included 216 Portuguese riders practicing HR at the time of the study with ≥1 year of experience. Data were obtained from a questionnaire that characterized first and second rider injuries; we opted for a systematic method to assess the riders’ injuries, in a temporal order. Questions regarding demographic data, sports-related background, systematic training workload, number and characteristics of the first 2 injuries, and the need for treatment were included in the questionnaire. Results: Most first and second injuries were musculoskeletal, occurred from falling off the horse during training, and primarily affected the lower limb. Rehabilitation was required in almost 50% of all cases. The occurrence of injury was significantly associated with the number of days of training per week, years of experience, height and weight of the rider, and practice of another sport. Riding different horses was also significantly associated with the number of injuries. Conclusions: The most frequently occurring injuries during HR are musculoskeletal and in the extremities. Injury prevention is essential in HR, as most riders have at least one injury while practicing. Rehabilitation should involve a physiatrist and core strengthening exercises.

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Secondary School Athletic Trainers’ Strategies and Barriers to Overuse Injury Treatment in Adolescent Athletes

Kevin M. Biese, Madeline Winans, Grace Rudek, Mayrena I. Hernandez, Lisa Cadmus-Bertram, Susan J. Andreae, M. Alison Brooks, Stephanie Kliethermes, Timothy A. McGuine, and David R. Bell

Context: Studies have illustrated that overuse injuries occur in adolescent athletes more often than previously reported. The general purpose of this study was to provide a thorough report of secondary school athletic trainers encounters, practices, and perceptions of overuse injury in adolescent athletes. Design: Cross-sectional. Methods: An anonymous online questionnaire was distributed via email to athletic trainers in the secondary school setting. The questionnaire was sent to participants during the summer of 2021 and 430 participants (highest educational degree earned: master’s degree = 66%) completed the survey. Various survey methods were used to evaluate athletic trainers (1) demographics, (2) estimations about what percentage of injuries evaluated and treated were classified as overuse, (3) methods for treating overuse injuries, (4) confidence in treating overuse injuries and the complete implementation of their treatment plan, (5) perceptions of various barriers to treating overuse injuries, and (6) perception as to why patients did not want to reduce activity to treat their overuse injuries. Results: Participants reported that about half of all evaluations and treatments in a year were overuse injuries and they were “fairly” or “completely” confident (90%) in their ability to treat these injuries. The most common treatments cited were stretching (91%) and reducing activity (90%). Only 61% of participants were “fairly” or “completely” confident in the complete implementation of their treatment plan. Participants believed that patients’ reluctance to reduce sport activities (82% “moderate” or “extreme” barrier) was the most significant barrier to treatment. Participants cited athletes’ avoidance of missing games as the most common reason athletes were reluctant to reduce sporting activity. Conclusions: Participants felt confident in treating overuse injuries yet faced significant barriers in treating these injuries. Clinicians should be prepared to have conversations about the importance of reducing sporting activity to allow proper healing for overuse injuries in adolescent athletes.

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Mechanical Evaluation of the Resistance of Theraband CLX

Rodrigo Martín-San Agustín, Francesc Medina-Mirapeix, Mariano Gacto-Sánchez, Germán Cánovas-Ambit, and Aurelio Arenas-Della Vecchia

Context: Calculating the resistance provided by elastic resistance is essential with the aim of adjusting the load and controlling the progression of the exercises in programs using elastic resistance. This study aimed (1) to establish a model of the force elongation for CLX bands; (2) to examine whether these models are altered by different aspects of band elongation: the phase of elongation and shortening (concentric and eccentric phases), the elongation speed, and the initial resting length; and (3) to determine the resistance value for 100% of elongation in each color and to compare it with the values reported by Theraband. Design: Cross‐sectional. Methods: Ten CLX bands of each color were elongated by 2 experienced researchers to establish their elongation force curves in series of 10 repetitions per band using a Smith machine for an anchor, examining whether elongation force models were affected by elongation and shortening phases using one 4-loop CLX band stretched to 100% and at 0.50 m/s, elongation speed stretching two 4-loop CLX bands at 0.50 m/s and at 0.70 m/s, and different starting lengths using 3 CLX bands (2, 3, and 4 loops) stretched at 0.50 m/s. Results: No differences were found in the comparisons between phases, speeds, or different start lengths (mean errors ranged from 0.01 [0.07 N] for the blue band to 2.97 [0.94 N] for the gold band). Our values were higher than the reference values provided by Theraband for all colors, ranging from 2.3% to 33.1%. Conclusions: Our findings show that the values provided by the brand underestimate the resistance provided by CLX bands. To solve this, regression equations are provided so professionals can calculate the resistance of CLX bands based on their elongation. In addition, these models are not influenced by the phase of elongation and shortening, the elongation speed, and the initial resting length.

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Rolling the Field Forward: The Power of Numbers in Ankle Injury Research

Christopher J. Burcal

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Blood Flow Restriction Training in Clinical Rehabilitation: Occlusion Pressure Methods Relative to the Limb Occlusion Pressure

Iván Chulvi-Medrano, Juan Manuel Cortell-Tormo, Sergio Hernández-Sánchez, Moisés Picón-Martínez, and Nicholas Rolnick

Context: Resistance training with blood flow restriction (BFR) has increased in clinical rehabilitation due to the substantial benefits observed in augmenting muscle mass and strength using low loads. However, there is a great variability of training pressures for clinical populations as well as methods to estimate it. The aim of this study was to estimate the percentage of maximal BFR that could result by applying different methodologies based on arbitrary or individual occlusion levels using a cuff width between 9 and 13 cm. Design: A secondary analysis was performed on the combined databases of 2 previous larger studies using BFR training. Methods: To estimate these percentages, the occlusion values needed to reach complete BFR (100% limb occlusion pressure [LOP]) were estimated by Doppler ultrasound. Seventy-five participants (age 24.32 [4.86] y; weight: 78.51 [14.74] kg; height: 1.77 [0.09] m) were enrolled in the laboratory study for measuring LOP in the thigh, arm, or calf. Results: When arbitrary values of restriction are applied, a supra-occlusive LOP between 120% and 190% LOP may result. Furthermore, the application of 130% resting brachial systolic blood pressure creates a similar occlusive stimulus as 100% LOP. Conclusions: Methods using 100 mm Hg and the resting brachial systolic blood pressure could represent the safest application prescriptions as they resulted in applied pressures between 60% and 80% LOP. One hundred thirty percent of the resting brachial systolic blood pressure could be used to indirectly estimate 100% LOP at cuff widths between 9 and 13 cm. Finally, methodologies that use standard values of 200 and, 300 mm Hg far exceed LOP and may carry additional risk during BFR exercise.

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Altered Ankle Muscle Activation at 2-Year Post Achilles Tendon Repair: An Age, Gender, and Activity Level-Matched Comparison With Healthy Subjects

Fırat Tan, Hande Guney-Deniz, Gulcan Harput, Burak Ulusoy, Gürhan Dönmez, John Nyland, and Mahmut N. Doral

Context: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Design: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Methods: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Results: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Conclusions: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level of Evidence: Level III.

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The Effect of McGill Core Stability Training on Movement Patterns, Shooting Accuracy, and Throwing Performance in Male Basketball Players: A Randomized Controlled Trial

Masumeh Hessam, Koroush Fathalipour, Amin Behdarvandan, and Shahin Goharpey

Context: Core stability training has been recommended as a vital element in improving movement’s pattern and athletic performance. The main objective of this study was to investigate the effect of 12-week McGill core stability training on movement patterns, shooting accuracy, and throwing performance. Design: Randomized controlled clinical trial. Setting: University research laboratory. Methods: Forty male basketball players were randomly assigned to experimental and control groups. The experimental group completed 12-week McGill core stability training, while the control group completed routine exercise training. Patterns of functional movements was measured through functional movement screen (FMS), shooting accuracy measured by static 3-point shooting (S3P) and dynamic 60-second 3-point shooting test, and throwing performance measured by Functional Throwing Performance Index. Results: Comparison revealed that regardless of received training, after 12 weeks both groups showed significant improvement in all outcome measures. However, experimental group had significantly higher post test scores in FMS (P = .02), S3P (P = .007), and dynamic 60-second 3-point shooting test (P = .01). For Functional Throwing Performance Index, there was no group differences (P = .96). The results of follow-up assessments showed for all measurements including FMS (P = .03), S3P (P = .004), dynamic 60-second 3-point shooting test (P < .001), and Functional Throwing Performance Index (P = .005); experimental group had higher scores than the control group. Conclusions: According to the results, implementing McGill core stability training in basketball routine training would be advisable since significant improvement can be obtained in the measured parameters.

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Priming Effects of Anodal Transcranial Direct Current Stimulation on the Effects of Conventional Physiotherapy on Balance and Muscle Performance in Athletes With Anterior Cruciate Ligament Injury

Zeinab Tohidirad, Fatemeh Ehsani, Rasool Bagheri, and Shapour Jaberzadeh

Context: In athletes, postural control impairment and knee muscle dysfunction are the most common disorders following anterior cruciate ligament (ACL) injury. Because of functional changes in the motor cortex following ACL injury, physiotherapy (PT) is not enough for treatment and using neuromodulators, such as trans-cranial direct current stimulation (tDCS) may be necessary. The present study focused on the effects of anodal tDCS (a-tDCS) over the primary motor cortex (M1) concurrent with PT on postural control and muscular performance in the athletes with ACL injury. Design: In this study, 34 athletes with ACL injury were randomly assigned in 2 groups of intervention group (active M1 a-tDCS concurrent with PT, n = 16) and control group (sham M1 a-tDCS concurrent with PT, n = 16). Methods: The participants of all groups received 20-minute 2 mA M1 a-tDCS with PT during 10 sessions, while tDCS was turned off after 30 seconds in the sham group. Before, immediately following, and 1 month after the interventions, the center of pressure and the average of power of flexor and extensor muscles at 2 velocities of 30°/s and 60°/s were measured by force plate and isokinetic devices, respectively. Results: One month after treatment, the displacement of center of pressure was decreased in the intervention group (P < .05), while there were no changes in the control group. Y-axis of center of pressure decreased in the intervention group relative to the control group, although average of power of flexor and extensor muscles increased immediately in both groups, but the rise in the intervention group was larger than that in the control group (P < .05). Conclusion: The findings indicated that M1 a-tDCS can induce the efficacy of PT, which has a lasting effect on the improvement of the postural control in athletes with ACL injury.