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Why Is There a Range in Time Returning to Preoperative Activity Habits After Femoroacetabular Impingement Treatment in Recreational Athletes?

Nils Wirries, Marco Ezechieli, Michael Schwarze, Alexander Derksen, Stefan Budde, Manuel Ribas, Henning Windhagen, and Thilo Floerkemeier

Context: Professional athletes showed excellent results after hip preserving procedures. However, there is still a lack of knowledge regarding the rate of return to activity and the rehabilitation time of recreational athletes. Thus, the aim of this study was to investigate factors that were associated with an extended return-to-activity time in nonprofessional athletes. Design: Retrospective, quantitative case–control study. Methods: This study included 47 cases (45 nonprofessional athletes), which were divided according to return-to-activity time (short term: 0.0–7.0 mo vs long term: >7.0 mo). The clinical outcome were evaluated with the modified Harris hip score, the nonarthritic hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the University of California, Los Angeles activity score. For statistical analysis between both groups, an unpaired student t test and a paired Wilcoxon test were used. In addition, the sports behavior, intraoperative findings, and surgical procedures were also assessed. Results: After a mean follow-up of 4.3 years (±0.6; 3.4–5.6), the overall postoperative modified Harris hip score was 81.8 points, the nonarthritic hip score was 75.8 points, the Western Ontario and McMaster Universities Osteoarthritis Index was 36.7 points, and the University of California, Los Angeles activity score was 7.9. Compared with the preoperative results, all scores improved significantly (P < .001). Patients of the short-term return-to-activity group showed a higher preoperative activity diversity and, postoperatively, a higher rate in high-impact sports (P = .024). Conclusions: After mini-open arthrotomy for femoroacetabular impingement syndrome treatment, 92.5% of the recreational athletes returned to sports activity. The findings did not detect factors influencing the return-to-activity time. However, a higher preoperative diversity of activities and a shift to high-level impact sport activities might support a shorter rehabilitation.

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Does Accelerated Rehabilitation Provide Better Outcomes Than Restricted Rehabilitation in Postarthroscopic Repair of Meniscal Injury?

Mingke You, Lingcheng Wang, Ruipeng Huang, Kaibo Zhang, Yunhe Mao, Gang Chen, and Jian Li

Context: Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. Objective: To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). Evidence Acquisition: Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. Evidence Synthesis: Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = −4.66; 95% confidence interval, −8.6 to −0.73; P = .02; I 2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior–posterior view (mean difference = −7.08; 95% confidence interval, −10.92 to −3.24; P = .0003; I 2 = 0%) and lateral view (mean difference = −10.33; 95% confidence interval, −16.9 to −3.75; P = .002; I 2 = 17%). Conclusion: This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.

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Musculoskeletal Injuries in Elite Collegiate Tenpin Bowling Athletes

Briana L. Zabierek, Walter C. Wilson, and Frank E. DiLiberto

Context: Collegiate tenpin bowling participation is increasing. Accordingly, the experience level of athletes participating, factors related to performance, as well as training workload and sport specialization are likely evolving. However, literature regarding injury rates remains extremely limited. The purpose of this study was to characterize injuries in collegiate tenpin bowlers. Design: Retrospective cohort survey study. Methods: Tenpin bowling athletes of top-ranked collegiate programs in the United States were invited to participate. Each participant completed an online survey to report on their injury history and additional factors of interest. Descriptive statistics were generated for participant characteristics, injury counts, and overall injury prevalence and recurrence. Chi-square tests were used to determine if overall injury prevalence and recurrence occurred by chance, and to evaluate the influence of gender and conditioning program participation on injury frequencies. Results: The response rate was 40.6% (101/249; N = 101). The sample was 20.02 (1.43) years old and 54.5% female. There were a total of 235 singular and recurrent injuries reported across all body parts. Upper-extremity injuries were the most common (n = 112). Injury prevalence (87%) and recurrence (75%) were more likely than chance (χ 2 > 21.3, both P < .001) and not different based on gender (χ 2 ≤ 1.1, both P ≥ .33). Injuries were more frequent in the absence of a conditioning program (χ 2 = 50.6, P < .001). Conclusions: Injuries and injury recurrence in elite tenpin bowlers were frequent, most common in the upper-extremity, not different based on gender, and more frequent in those without conditioning programs. Findings may serve as foundational knowledge for developing sport-specific rehabilitation and conditioning programs.

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Exploring the Relationship Between Mental Toughness and Self-Compassion in the Context of Sport Injury

Karissa L. Johnson, Danielle L. Cormier, Kent C. Kowalski, and Amber D. Mosewich

Helping athletes cope effectively with injury is likely of great interest to many sport stakeholders. Mental toughness is one psychological factor positively associated with resilience and sport performance, though stubborn persistence through injury might not always be conducive to adaptive athlete outcomes. Self-compassion—a balanced, nonjudgmental approach in relating to oneself when experiencing suffering—might help circumvent these pitfalls and complement injury recovery. The purpose of this study was to explore the relationship between mental toughness and self-compassion in a sport injury context. This study consisted of 2 phases—phase I quantitatively assessed the relationships between mental toughness, self-compassion, and other psychological constructs, while phase II used qualitative interviews to corroborate and inform these findings. In phase I, competitive athletes who were injured at the time of data collection (n = 81) completed mental toughness, self-compassion, coping resources, self-esteem, and self-criticism questionnaires. Self-compassion was positively correlated with mental toughness (r = .48, P < .01), coping resources (r = .54, P < .05), and self-esteem (r = .60, P < .01). Self-compassion and self-criticism were negatively correlated with each other (r = –.52, P < .01). Results from hierarchical multiple regression analyses revealed that self-compassion was a significant predictor of mental toughness (ΔR 2 = .07, P < .01), coping resources (ΔR 2 = .10, P < .01), and self-criticism (ΔR 2 = .06, P < .01), beyond the effects of self-esteem. Four injured athletes who scored above the median on mental toughness and self-compassion measures were interviewed in phase II. Thematic analysis generated 2 themes: (1) self-compassion grants access to wise mental toughness and (2) mental toughness helps activate self-compassionate actions during injury. These findings are consistent with recent research and suggest that both mental toughness and self-compassion can work together to help athletes cope with sport injury.

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Efficacy of an Audio-Based Biofeedback Intervention to Modify Running Gait in Female Runners

Jacqueline A. Augustine, Sarah Rothstein, Larissa True, and Kevin D. Dames

Context: A variety of gait retraining interventions are available to modify running mechanics associated with musculoskeletal injuries. These often require specialized equipment and/or personnel to prompt the runner toward specific strategies. Objective: To determine whether instructing female recreational runners to “run quietly” could decrease impact force characteristics. Design: Cohort. Setting: Research laboratory. Participants: Fifteen healthy female recreational runners (24 [7] y) volunteered. Interventions: Baseline testing occurred on day 1 (baseline), a posttraining assessment occurred on day 2 (training), and a final assessment occurred 1 week after training on day 3 (follow-up). A smartphone decibel measuring app was used to provide biofeedback on the decibel level of foot strike on day 2 (training). Main Outcomes: Peak vertical force, impact transient, peak and average vertical loading rate, ground contact time, and running economy were collected on each day and compared via repeated-measures analyses of variance. Results: Vertical ground reaction force was lower at follow-up (2.30 bodyweights [BW]) versus baseline (2.39 BW, P = .023) and training (2.34 BW, P = .047). Maximal loading rate decreased from baseline (69.70 BW·s−1) to training (62.24 BW·s−1, P = .021) and follow-up (60.35 BW·s−1, P = .031). There was no change in running economy. Conclusions: Our findings demonstrate that simple instructions to “run quietly” can yield immediate and sustained reductions in impact force profiles, which do not influence running economy.

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Ultrasound-Guided Percutaneous Needle Electrolysis Combined With Therapeutic Exercise May Add Benefit in the Management of Soleus Injury in Female Soccer Players: A Pilot Study

Blanca De-la-Cruz-Torres, Beatriz Romero-Rodríguez, and Carlos Romero-Morales

Context: The performance of sprints during male soccer matches usually is slow medium paced, where the soleus and gastrocnemius (ankle plantar flexors) play a very important role. As in male soccer, soleus injuries should be considered in female soccer; but the scientific evidence is very limited in this case. Design: Pilot clinical trial study. Objective: To determine whether adding an ultrasound-guided percutaneous needle electrolysis (US-guided PNE) technique to a specific exercise program improved perceived pain at stretching and at palpation, ankle dorsiflexion range of motion, muscle fatigue, and sport performance in women soccer players with soleus injury. Methods: This pilot study recruited 20 female players with chronic soleus injury (type 1, characterized by hypoechoic image) who were assigned to one of 2 groups: an experimental group (exercise program + US-guided PNE; n = 10) or a control group (exercise program + sham stimulation; n = 10). Pain intensity, dorsiflexion range of motion, knee-flexion heel raise test, curve sprint test, and the global rating of change scale were analyzed at baseline and after treatment (4 wk) and there was no further follow-up. Results: Pain intensity at palpation and at stretching, dorsiflexion range of motion, and heel raise test values showed significant improvements (P < .05) between pretreatment and posttreatment for both groups, however, no significant differences were observed between groups. Curve sprint tests did not show significant differences between pretreatment and posttreatment for either group or between groups. However, the percentage of changes always revealed better values in favor of the PNE group. Both groups showed good player satisfaction with the therapies. Conclusion: The application of the US-guided PNE combined with a specific exercise program may cause clinical benefits in the treatment of female soccer players with soleus injury.

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The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis

Eleftherios Paraskevopoulos, George Koumantakis, and Maria Papandreou

Context: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. Objective: To determine the effectiveness of NE in CR on pain, function, and ROM. Design: Systematic review and meta-analysis. Evidence Acquisition: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. Evidence Synthesis: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was −1.33/10 (95% confidence interval [CI], −1.80 to −0.86; P < .01; I 2 = 0%), for function with the Neck Disability Index was −1.21/50 (95% CI, −1.67 to −0.75; P < .01; I 2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I 2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I 2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. Conclusions: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.

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Intersession Variability of Knee Extension Kinetics Using a Strain Gauge Device With Differing Clinically Practical Physical Constraints

Christopher M. Juneau, Shelley N. Diewald, Jonathan Neville, John B. Cronin, and Dustin J. Oranchuk

Context: Intrasession reliabilities of isometric knee extension kinetics via portable strain gauge have been reported across several knee joint angles and constraints. However, intersession variabilities, which are more valuable, have yet to be determined. Therefore, we aimed to quantify the intersession variability of knee extension kinetics over 3 testing sessions using an affordable and portable strain gauge. Design: Participants performed maximum voluntary isometric contractions of the knee extensors over 3 sessions. Methods: Eleven (6 men and 5 women; 31 [6.4] y) volunteers performed maximum voluntary isometric contractions in constrained (isokinetic setup with thigh and chest straps) and unconstrained (treatment plinth) conditions. Peak force (PF), peak rate of force development, rate of force development (RFD), and impulse (IMP) from 20% to 80% of PF were assessed. Means, SDs, percentage changes, minimal detectable changes, coefficients of variation (CV), and intraclass correlation coefficients (ICC) were calculated and reported. Results: PF had the lowest intersession variability regardless of condition (CV = 5.5%–13.8%, ICC = .67–.93). However, variability of peak rate of force development (CV [range] = 12.2%–24.7%, ICC = .50–.78), RFD (CV = 10.0%–26.8%, ICC = .48–.84), and IMP (CV = 15.2%–35.4%, ICC = .44–.88) was moderate at best. The constrained condition (CV [SD] = 14.1% [4.8%], ICC = .74 [.08]) had lower variability compared with the plinth (CV = 19.8% [7.9%], ICC = .68 [.15]). Variability improved from sessions 1 to 2 (CV = 20.4% [7.7%], ICC = .64 [.14]) and to sessions 2 to 3 (CV = 15.3% [6.4%], ICC = .76 [.10]). Conclusions: PF can be assessed regardless of setup. However, RFD and IMP changes across sessions should be approached with caution. Backrests and thigh straps improve RFD and IMP variability, and at least 1 familiarization session should be provided before relying on knee-extensor kinetics while utilizing a portable strain gauge.

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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.