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Anterior–Posterior Center of Pressure Is Associated With Knee Extensor Moment During Landing After Anterior Cruciate Ligament Reconstruction

Masato Chijimatsu, Rui Henmi, Hiroko Yokoyama, Yuka Kimura, Yasuyuki Ishibashi, and Eiichi Tsuda

Context: A reduced knee extensor moment (KEM) in the involved limb and asymmetry in the KEM during landing tasks are observed after anterior cruciate ligament reconstruction (ACLR). There is limited information about the association of kinetic and kinematic parameters with the KEM during landing after ACLR. This study investigated the association of the anterior–posterior center of pressure (AP-COP) position, vertical ground reaction force (VGRF), and lower limb joint angles with the KEM during landing in female athletes following ACLR. Design: Cross-sectional study. Methods: Twenty-two female athletes who underwent ACLR performed a drop vertical jump at 7.9 (1.7) months after surgery. We evaluated the KEM, AP-COP position, VGRF, and sagittal plane hip, knee, and ankle angles using a 3-dimensional motion analysis system with force plates. Results: The peak KEM in the involved limb was significantly smaller than that in the uninvolved limb during landing (1.43 [0.33] N·m/kg/m vs 1.84 [0.41] Nm/kg/m, P = .001). The VGRF in the involved limb was significantly smaller than that in the uninvolved limb (11.9 [2.3] N/kg vs 14.6 [3.5] N/kg, P = .005). The limb symmetry index of the KEM was predicted by that of the VGRF (P < .001, R 2 = .621, β = 0.800). The KEM was predicted by the AP-COP position in the involved limb (P = .015, R 2 = .227, β = 0.513) and by the VGRF in the uninvolved limb (P = .018, R 2 = .213, β = 0.500). No significant correlation was noted between the KEM and the lower limb joint angles. Conclusions: The AP-COP position and VGRF were associated with the KEM during landing. Evaluating the VGRF and AP-COP position, not the lower limb joint angles, may contribute to understanding the KEM during double-leg landing after ACLR in the clinical setting.

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Kinesiotaping Is Not Better Than a Placebo: Kinesiotaping for Postural Control in Anterior Cruciate Ligament-Reconstructed Patients—A Randomized Controlled Trial

Salman Nazary-Moghadam, Zahra Abbasi, Reyhaneh Sekandari, Amin Razi, Afsaneh Zeinalzadeh, Somayyeh Rostami, and Mohammad Hossein Khabbaz Kababi

Objective: The primary aim of this study was to investigate the immediate and delayed effects of kinesiotape (KT) on postural control and patient-reported outcome measures under challenging conditions in individuals with anterior cruciate ligament reconstructions. Methods: Thirty-two anterior cruciate ligament-reconstructed patients for whom 6 months had passed since their operation were randomly assigned to either the KT (n = 16, aged 21.8 [5.5] y) or the placebo KT (n = 16, aged 24.0 [5.1] y) groups. Initially, both groups stood barefoot on a force platform while performing postural tasks in 4 randomized conditions (eyes open, eyes closed, cognitive task, and foam). Before the experiment, patients would bring the 4 conditions, which were written on folded papers, one by one, and in this way, the order of conditions for the examiners was determined. The patients’ evaluations were conducted immediately and 48 hours after KT application. Postural control measures, with area and displacement of the center of pressure (CoP) in anterior–posterior and medial–lateral directions, and mean total velocity displacement of CoP (MVELO CoP) served as dependent variables. In addition, the International Knee Documentation Committee score was measured pretreatment and 48 hours posttreatment. Results: Significant group-by-time interactions were observed for displacement of COP in medial–lateral direction (P = .002) and MVELO CoP (P = .034). MVELO CoP significantly decreased (mean difference = 0.60, P = .009) immediately after KT application compared with preapplication measures. In the placebo group, a statistically significant decrease in MVELO CoP (mean difference = 0.869, P = .001) was observed at 48 hours post-KT compared with preapplication values. International Knee Documentation Committee scores significantly improved at 48 hours post-KT application in both groups (P < .05). Conclusions: Though observed at different time points, both KT (immediately after the intervention) and placebo KT (48 h after the intervention) were found to improve postural control measures. It appears that the changes in postural control may be more related to proprioceptive enhancement due to KT rather than the specific KT pattern.

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Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series

Brian V. Hortz and Sue Falsone

Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

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Acute Effects of Local High-Frequency Percussive Massage on Deep Fascial and Muscular Stiffness and Joint Range of Motion in Young Adult Men

Zijian Liu, Yicheng Zhong, Toshihiro Maemichi, Qianhui Zhou, Takumi Okunuki, Yanshu Li, Wakamiya Kazuki, and Tsukasa Kumai

Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers’ ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: −0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently.

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The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review

Tamerah N. Hunt, Kylie Roberts, Erica M. Taylor, Carolina P. Quintana, and Melissa K. Kossman

Context: Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery. Objective: This review examined previous research that examined the effect of SDoH on concussion recovery of athletes. Evidence Acquisition: CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms “concussion” AND “recovery,” “youth, adolescent, teen and/or adult,” and “social determinants of health” and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. Evidence Synthesis: Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality. Conclusion: Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.

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Normative Standards for Isokinetic and Anthropometric Classifications of University-Level Netball Players

Kyra-Kezzia Duvenage, Yolandi Willemse, Hans de Ridder, and Mark Kramer

Context: The purpose of the study was to develop normative ranges and standards for knee and shoulder isokinetic and anthropometric values. These standards can be qualitatively interpreted and allow practitioners to classify isokinetic and anthropometric values more objectively for university-level netball players. Design: Posttest only observational study design. All players were only evaluated once during the in-season to generate normative ranges. Methods: A total of 51 female players volunteered. Participants were evaluated on an isokinetic dynamometer at 60° per second to obtain knee-extensor and knee-flexor values as well as shoulder-flexor and shoulder-extensor values. A total of 16 anthropometric variables were collected including stature, body mass, 8 skinfolds, and 6 circumferences. Between-group differences were calculated to determine whether playing level was a differentiating factor in data. Results: Normative standards were developed for isokinetic parameters associated with the knee and shoulder joints as well as skinfolds and circumference measures. No statistically significant between-group differences were evident (χ2 Kruskal–Wallis[2] = 3.96, P = .140). Conclusion: These standards can be used by coaches and practitioners to set attainable goals for individual players or those from secondary leagues, classify individual and team-based performances, and facilitate decision-making processes.

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Ozone Therapy for a Soccer Player With Osteitis Pubis: A Case Report

Merve Demir Benli and Beyza Arslan

Context: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. Case Presentation: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. Management and Outcomes: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient’s complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. Conclusion: In this article, we present a case in which OP was successfully treated with ozone injection.

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Volume 33 (2024): Issue 3 (Mar 2024)

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Translation and Adaptation of the Reinjury Anxiety Inventory, the Sport Injury Rehabilitation Adherence Scale, and the Athletic Injury Self-Efficacy Questionnaire Into Turkish

Hande Turkeri-Bozkurt, Sinan Yıldırım, Britton W. Brewer, Volga Bayrakcı Tunay, and Ziya Koruç

Context: Psychological difficulties can adversely affect rehabilitation outcomes and make return to sport more difficult. Identifying psychological difficulties is possible with valid and reliable measurement tools. The purpose of this study is to translate and culturally adapt the Reinjury Anxiety Inventory (RIAI), the Sport Injury Rehabilitation Adherence Scale (SIRAS), and the Athletic Injury Self-Efficacy Questionnaire (AISEQ) into Turkish and evaluate the psychometric properties of the Turkish versions. Design: Cross‐sectional study. Methods: The instruments were forward- and back-translated, culturally adapted, and validated on 248 athletes and 34 physical therapists. The physical therapists of the athletes completed the SIRAS to evaluate the athletes. Statistical analysis included reliability tests (Cronbach alpha and test–retest), exploratory factor analysis, confirmatory factor analysis, and correlational analysis. Floor and ceiling effects (<15%) were also assessed. Results: Confirmatory factor analyses revealed a satisfactory model fit for the RIAI and the AISEQ, and exploratory factor analysis revealed the 1-factor structure for the SIRAS as in the original. All 3 instruments displayed adequate internal consistency (Cronbach alpha coefficients ranged from .84 to .88) and test–retest reliability (coefficients ranged from .81 to .93). Convergent validity of the instruments was supported by significant correlations between the AISEQ and both the RIAI and the SIRAS. Conclusions: Our results suggest that the Turkish versions of the instruments were valid, consistent, and reliable in athletes who have serious injuries. Scores on these instruments could be useful for evaluating the contributions of psychological factors to return to sport following serious injuries. Clinicians are encouraged to use RIAI-Turkish (RIAI-TR), SIRAS-Turkish (SIRAS-TR), and AISEQ-Turkish (AISEQ-TR) together to make decisions about the treatment and rehabilitation plans of injured athletes.

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Impact of Prolonged Sport Stoppage on Knee Injuries in High School Athletes: An Ecological Study

Hannah Knapic, Ellen Shanley, Charles A. Thigpen, Albert Prats-Uribe, Cynthia D. Fair, and Garrett S. Bullock

Context: In March 2020, public health concerns resulted in school closure throughout the United States. The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019–2020 and 2020–2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region. Design: Historical–prospective cohort study. Methods: This historical–prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30, 2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years. Results: 94,847 and 72,521 high school athletes participated in the 2019–2020 (19–20) and 2020–2021 (20–21) seasons. Knee injury risk was higher in the 20–21 season (19–20: 28.89% [27.82–29.96]; 20–21: 33.82% [32.50–35.14]). Risk increased for male athletes from 2019–2020 to 2020–2021 (19–20: 29.42% [28.01–30.83]; 20–21: 40.32% [38.89–41.75]). Female knee injury risk was similar between years (19–20: 25.78% [24.29–27.27]; 20–21: 26.03% [24.31–27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1–1.3], P < .001) during 2020–2021. Conclusions: Knee injury risk and relative risk increased among males in 2020–2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk.