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Volume 31 (2022): Issue 8 (Nov 2022)

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Movement Regularity Differentiates Specialized and Nonspecialized Athletes in a Virtual Reality Soccer Header Task

Christopher D. Riehm, Scott Bonnette, Michael A. Riley, Jed A. Diekfuss, Christopher A. DiCesare, Andrew Schille, Adam W. Kiefer, Neeru A. Jayanthi, Stephanie Kliethermes, Rhodri S. Lloyd, Mathew W. Pombo, and Gregory D. Myer

Background: Young athletes who specialize early in a single sport may subsequently be at increased risk of injury. While heightened injury risk has been theorized to be related to volume or length of exposure to a single sport, the development of unhealthy, homogenous movement patterns, and rigid neuromuscular control strategies may also be indicted. Unfortunately, traditional laboratory assessments have limited capability to expose such deficits due to the simplistic and constrained nature of laboratory measurement techniques and analyses. Methods: To overcome limitations of prior studies, the authors proposed a soccer-specific virtual reality header assessment to characterize the generalized movement regularity of 44 young female athletes relative to their degree of sport specialization (high vs low). Participants also completed a traditional drop vertical jump assessment. Results: During the virtual reality header assessment, significant differences in center of gravity sample entropy (a measure of movement regularity) were present between specialized (center of gravity sample entropy: mean = 0.08, SD = 0.02) and nonspecialized center of gravity sample entropy: mean = 0.10, SD = 0.03) groups. Specifically, specialized athletes exhibited more regular movement patterns during the soccer header than the nonspecialized athletes. However, no significant between-group differences were observed when comparing participants’ center of gravity time series data from the drop vertical jump assessment. Conclusions: This pattern of altered movement strategy indicates that realistic, sport-specific virtual reality assessments may be uniquely beneficial in exposing overly rigid movement patterns of individuals who engage in repeated sport specialized practice.

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The Influence of Age and Dynamic Balance on Functional Movement Among Active-Duty Police Officers

Madison N. Renner, Stacy L. Gnacinski, Franchesca J. Porter, and David J. Cornell

Context: Although occupational injuries for police officers cannot be prevented, factors that contribute to musculoskeletal injury risk could be better identified to inform preventative interventions. Previous research has supported screening tools such as the functional movement screen (FMS) and Y-Balance Test (YBT) as possible indicators of musculoskeletal injury risk. The purposes of this study are to (1) examine the relationships between age, dynamic balance, and functional movement in police officers and (2) determine how much variance in functional movement is predicted by age and dynamic balance. Methods: This study was conducted in a university research laboratory as part of an ongoing collaboration with a local police department. All data for the current study were collected across 2 separate laboratory visits within a 14-day period. Participants: Thirty-five active-duty police officers (31 men and 4 women; mean [SD], age 33.4 [9.4] y, height 177.4 [8.0] cm, body mass 88.4 [15.3] kg) volunteered to participate in this study. Main Outcome Measures: Functional movement was assessed using the FMS, and FMS overall scores were calculated. Dynamic balance was assessed via the YBT, and lower quarter Y-Balance Test scores (LQYBT%) were calculated. Results: There was a significant negative correlation between FMS overall score and age (r = −.641, P < .001). Correlations between FMS overall score and LQYBT% and between LQYBT% and age were not statistically significant. Age and LQYBT% scores significantly predicted FMS overall scores (F 2,32 = 11.162, P < .001), accounting for 41.1% of the variance in FMS overall scores (R 2 = .411) with age being the only significant predictor. Conclusions: This study confirms that age and FMS overall score have a strong, negative relationship, suggesting that age may be a contributing factor to movement quality and may lead to an increased risk of musculoskeletal injury within this unique population.

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Consequences of Sport-Related Concussion on Health-Related Quality of Life in Adolescents: A Critically Appraised Topic

Mary Margaret Williamson and Jessica Wallace

Clinical Scenario: Sport-related concussions (SRCs) are a prevalent and problematic injury occurring among adolescents participating in sports. Health-related quality of life (HRQoL) has been shown to be affected in a portion of adolescents recovering from SRCs, though the exact nature of the relationship has yet to be firmly established for this age group through the duration and completion of recovery. HRQoL can be a nebulous construct but is often described as multifaceted and demonstrates effects of an illness, injury, or condition on one’s overall well-being, encompassing satisfaction and comfortability of physical, psychosocial, sleep, and cognitive attributes. Clinical Question: How do adolescents diagnosed with sport-related concussion perceive changes in health-related quality of life domain measures throughout recovery? Summary of Key Findings: Four studies met the inclusion criteria, including 1 longitudinal prospective case series and 3 longitudinal prospective cohort studies. The literature indicated that adolescents who sustained an SRC reported an initial immediate decrease in overall HRQoL as well as domains including cognitive, physical, school, and sleep. This initial decrease was particularly notable in those with delayed recovery or those diagnosed with post-concussion syndrome. Despite the initial decrease, all participants of varying SRC recovery duration reportedly returned to healthy, normative levels of HRQoL upon recovery. Clinical Bottom Line: Adolescents reportedly experience initial decreases in various HRQoL domains immediately after SRC but appear to rebound to a healthy status upon recovery regardless of recovery duration. Strength of Recommendation: Results of the review of 4 longitudinal studies established level B evidence.

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More Physical Activity Is Correlated With Reduction in Kinesiophobia for Adolescents With Persistent Symptoms After Concussion

Katherine L. Smulligan, Mathew J. Wingerson, Corrine N. Seehusen, Casey C. Little, Julie C. Wilson, and David R. Howell

Context: The relationship between physical activity (PA) and fear of pain with movement (ie, kinesiophobia) during concussion recovery is unknown. Kinesiophobia may limit PA, while PA after concussion may reduce kinesiophobia. Our purpose was to examine the correlation between PA and self-reported kinesiophobia during concussion recovery for adolescents with and without persistent symptoms. Design: Prospective cohort study of children ages 10–18 years within 14 days of concussion. Methods: Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 d postconcussion) and return to play (RTP) assessments, and wore activity monitors between assessments. Our primary outcome was TSK score change from initial to RTP assessments. We grouped participants based on whether they experienced persistent symptoms (symptoms ≥28 days) or not (symptoms <28 days) and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for nonnormally distributed variables) between PA variables and TSK change scores. Results: Among the 41 participants enrolled, 44% developed persistent symptoms (n = 18; age = 14.5 [2.0] y; 50% female; symptom duration = 57.3 [6.2] d; RTP = 66.8 [6.4] d) and 56% did not (n = 23; age = 14.9 [1.8] y; 48% female; symptom duration = 15.2 [1.5] d; RTP = 21.7 [1.9] d). For the persistent symptoms group, greater TSK change scores (mean = −2.5 [5.7] point change) were significantly and moderately correlated with higher daily step count (r = −.60, P = .008) and exercise frequency (r = −.63, P = .005), but were not correlated with exercise duration (ρ = −.12, P = .65). Among the no persistent symptoms group, TSK change scores (mean = −6.0 [5.0] point change) were not correlated with step count (r = −.18, P = .41) or exercise duration (ρ = .10, P = .67), and the correlation with frequency was low and not significant (r = −.34, P = .12). Conclusions: Regular PA during concussion recovery, regardless of duration or intensity, may help reduce kinesiophobia for those experiencing persistent symptoms.

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Effectiveness of Dry Cupping as a Treatment for Plantar Fasciitis: A Critically Appraised Topic

Philip A. Szlosek and Matthew Campbell

Clinical Scenario: Plantar fasciitis is a very common pathology experienced by a wide array of individuals in the United States. Patients most commonly experience tightness and pain along the plantar aspect of their foot and on the medial side of the heel. A variety of treatment methods have been used to improve the pain levels and function of patients with plantar fasciitis. An emerging treatment method for plantar fasciitis is dry cupping, where negative pressure is created to increase blood flow to the injured area and facilitate the healing process. Clinical Question: Is there evidence to suggest dry cupping is effective at improving pain and function for patients experiencing plantar fasciitis when compared with therapeutic exercise or electrical stimulation? Summary of Key Findings: Three studies examining the effectiveness of dry cupping for the treatment of plantar fasciitis were included in this review. Two studies compared dry cupping to therapeutic exercises and stretching, and 1 study used electrical stimulation. Clinical Bottom Line: There is moderate evidence to support the use of dry cupping to improve pain and function in patients with plantar fasciitis. Strength of Recommendation: There is level B evidence to support dry cupping as an effective treatment method for improving pain and function in patients with plantar fasciitis as compared with therapeutic exercise and electrical stimulation.

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Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey

Diego H. Méndez, Pablo O. Policastro, and Danilo De Oliveira Silva

Context: Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load. Design: A cross-sectional multinational online open-survey. Methods: The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021. Results: 72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%). Conclusions: Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

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Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults

Chloe McKay, Johanna M. Hoch, Matthew C. Hoch, and Deirdre Dlugonski

Context: Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18–25 y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. Design: Retrospective, cross-sectional study design. Methods: Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). Results: When controlling for age, there were no statistically significant differences in physical literacy (F 2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F 2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). Conclusions: Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

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The Sleep Parameters of Paralympic Athletes: Characteristics and Assessment Instruments

Isadora Grade, Henrique Andrade, Renato Guerreiro, Eduardo Stieler, Flavia R. da Silva, Hesojy G.V. da Silva, Roberto Vital, Renan A. Resende, Dawit A.P. Gonçalves, André G. Andrade, Marco T. de Mello, and Andressa Silva

Context: Sleep serves many important functions for athletes, particularly in the processes of learning, memory, recovery, and cognition. Objectives: Define the sleep parameters of Paralympic athletes and identify the instruments used to assess and monitor sleep Paralympic athletes. Evidence Acquisition: This systematic review was carried out based on the PRISMA guidelines. The survey was conducted in April 2020, the searches were carried out again in September 2021 to check whether there were new scientific publications in the area of sleep and Paralympic sport, searches were performed in the following databases: PubMed, Web of Science, Scopus, SPORTDiscus, Virtual Health Library (BIREME), and SciELO. This systematic review has included studies that investigated at least one of the following sleep parameters: total sleep time, sleep latency, sleep efficiency, number of awakenings, quality of sleep, daytime sleepiness, and chronotype; the participants were comprised of athletes with disabilities. Studies published at any time in English, Portuguese, and Spanish, were included. Evidence Synthesis: Data extraction and study selection were performed by 2 researchers independently, and a third author was consulted as necessary. The search returned a total of 407 studies. Following the screening based on exclusion and inclusion criteria, a total of 13 studies were considered. Paralympic athletes have a low amount (7.06 h) of sleep with poor quality and sleep latency (28.05 min), and 57.2% have daytime sleepiness, with the majority belonging to the indifferent chronotype (53, 5%). Moreover, 11 studies assess sleep using subjective instruments (questionnaires), and 2 studies used an objective instrument (actigraphy). Conclusions: Sleep disorders are common among Paralympic athletes, poor sleep quality and quantity, and high rates of daytime sleepiness. Subjective methods are most commonly used to assess sleep.

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Blood Flow Restriction Therapy for Use After Extremity Fracture: A Critically Appraised Topic

Ian Robertson, Marina Lazarides, and Cody R. Butler

Clinical Scenario: Blood flow restriction (BFR) therapy has emerged as a viable treatment option to enhance clinical recovery in patients with primarily muscular injuries. However, BFR therapy has been rarely investigated in patients with osseous injuries to include extremity fracture. Focused Clinical Question: Does BFR-enhanced therapy improve clinical outcomes in patients during the acute to subacute rehabilitation period after extremity fracture? Summary of Key Findings: (1) In cases of 2 high-performing athletes with talus and osteochondral fracture of the knee, BFR was well tolerated and an effective rehabilitation regimen. (2) In 2 randomized controlled trials evaluating BFR use in patients after operative and nonoperative management of distal radius fractures, pain with activity and self-perceived function were improved in BFR-enhanced therapy as compared with a standard rehabilitation regimen. (3) Objective clinical outcomes including radiographic healing, extremity range of motion, and grip strength evaluated by the randomized controlled trials did not differ significantly between the BFR-enhanced and standard rehabilitation groups. Clinical Bottom Line: BFR-enhanced therapy may improve pain and self-perceived function of the injured extremity during the acute to subacute rehabilitation period after fracture. However, there is not yet a demonstrated benefit of BFR on hastening objective measures of clinical recovery. Large-scale clinical trials comparing BFR-enhanced rehabilitation with standard rehabilitation regimens are needed to better characterize BFR use in patients with osseous injuries. Strength of Recommendation: Two case reports and 2 randomized controlled trials provide level IIB evidence suggesting that BFR may improve pain in the acute rehabilitative stage and improve the patient’s perceived function of the injured extremity, without greater improvement in objectively measured clinical parameters as compared with a standard rehabilitation regimen.