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.
Fırat Tan, Hande Guney-Deniz, Gulcan Harput, Burak Ulusoy, Gürhan Dönmez, John Nyland, and Mahmut N. Doral
Emily H. Gabriel and Cameron J. Powden
Identification of factors which may influence participation in exercise-related injury prevention programs within Reserve Officers’ Training Corps (ROTC) cadets is an important step in improving adoption and adherence rates. Therefore, the purpose of the study was to identify factors associated with intention to participate in an exercise-related injury prevention program within ROTC cadets. Theory of planned behavior scale perceived benefits (B = 3.65, η2 = .36, p = .001) and Health Belief Model Scale perceived benefits (B = 3.46, η2 = .31, p = .01) had a large positive association with intention to participate. Theory of planned behavior scale perceived barriers (B = −2.28, η2 = .37, p = .001) had a large negative association with intention to participate. Implementation strategies for exercise-related injury prevention programs may need to focus on the benefits and barriers of participation to increase adoption and adherence.
Russell L. Muir
Athletic trainers frequently make decisions under uncertain conditions leading to the use of decisional shortcuts (heuristics). Heuristics can be useful decisional tools, but their use gives rise to predictable cognitive errors (cognitive bias), which can lead to diagnostic and injury management errors. This study assessed athletic trainers’ understanding of these topics and explored their presence in athletic training education. Few participants were taught about heuristics (11.6%) and cognitive bias (24.1%), although those taught about heuristics demonstrated greater understanding of both topics. To improve clinical efficacy and patient outcomes, athletic trainers should seek educational opportunities related to heuristics and cognitive bias.
Lindsey E. Slavin, Tess M. Palmateer, Trent A. Petrie, and E. Whitney G. Moore
The onset of COVID-19 and cancellation of collegiate sports may have exacerbated student-athletes’ psychological distress. Within a national sample of collegiate athletes (N = 5,755; 66.7% women), we determined how gender and race related to rates of depression, stress, and counseling use at the beginning of the pandemic (April/May 2020). Overall, 26.5% (n = 1,526) and 10.6% (n = 612) endorsed clinical levels of depression and stress, respectively; 25.1% (n = 1,443) and 69.7% (n = 4,014) reported subclinical levels. Few athletes (2.3%–17.1%) reported counseling use before or after the onset of COVID-19; those who did reported higher levels of depression and stress than those who never sought services. The female athletes reported higher rates of depression, stress, and counseling use than the male athletes. There were no race effects. Athletic departments must address their student-athletes’ psychological distress by facilitating a higher use of mental health services.
Martin Alfuth, Pia Joana Franke, Jonas Klemp, and Axel Johannes Knicker
Context: After anterior cruciate ligament reconstruction (ACLR), long-term functional deficiencies can occur, with controversial results reported when comparing women and men. Dynamic balance and unilateral hop test performance are considered important indicators for the risk of reinjury of the lower extremity. Although both sexes seem to have a similar risk to experience a second anterior cruciate ligament injury, sex-specific differences of dynamic balance and unilateral hop performance in handball players following ACLR are unknown. Objective: To compare dynamic balance and unilateral hop performance between women and men handball players at least 6 months after ACLR. Design: Cross-sectional pilot study. Participants: Ten women (27.6 [4.5] y) and 10 men (26.5 [3.1] y) handball players 6 to 16 months after ACLR. Outcome Measures: Dynamic balance and unilateral hop performance were assessed using the Y-Balance Test and the Single-Leg Hop for Distance Test. Results: Women players demonstrated significantly better results in the anterior direction of the Y-Balance Test for both legs compared with men players. Hop performance was not significantly different between sexes. Conclusion: Dynamic balance and single-leg hop performance seem not to differ between women and men handball players 6 to 16 months after ACLR. The difference between sexes in the anterior reach direction of the Y-Balance Test should be considered small, rather than representing a true difference.
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).
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.
Ian Brewer, Josh Zimmerman, Marcie Fyock-Martin, Nelson Cortes, and Joel Martin
Clinical Question: Does reactive neuromuscular training (RNT) increase gluteal muscle activation during squatting movements? Clinical Bottom Line: The current best evidence suggests RNT may result in acute increases of gluteus maximus and gluteus medius muscle activation when performing the barbell back squat exercise; however, the findings were inconsistent and unclear for other types of squatting movements. Grades B and D evidence exists on the effects of RNT to increase gluteus maximus and medius muscle activation, respectively, during squatting movements. Given the methodological differences and mixed findings reported in this critically appraised topic, practitioners should carefully consider whether using RNT would be appropriate for a given clinical scenario.
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.