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Chee Vang and Alexander Niznik

Clinical Scenario: Patellar tendinopathy is a common musculoskeletal disorder affecting the lower-extremities and a difficult condition to manage for athletes that are in season. To facilitate improvement in function and to decrease pain, initial treatment for patellar tendinopathy is typically conservative. Traditional interventions may include eccentric training, cryotherapy, patellar counterforce straps, oral anti-inflammatories, injectable agents, phonophoresis, iontophoresis, orthotics, therapeutic ultrasound, and extracorporeal shockwave. In addition, recent literature suggests that implementing isometric and isotonic contractions may be effective in reducing patellar tendon pain. Focused Clinical Question: How effective are isometric contractions compared with isotonic contractions in reducing pain for in-season athletes with patellar tendinopathy? Summary of Key Findings: Implementation of isometric and isotonic exercises statistically reduced pain levels in the short term of 4 weeks for in-season athletes; however, isometric contractions provided statistically greater pain relief immediately for up to 45 minutes postintervention compared with isotonic contractions. Clinical Bottom Line: Current evidence supports the use of isometric and isotonic contractions to reduce pain for in-season athletes with patellar tendinopathy. Based on the reviewed literature, clinicians should consider utilizing heavy loaded isometrics or progressive heavy loaded isotonic exercises, which showed reduction in pain levels immediately after intervention and at 4-week follow-up for both intervention groups. Isometric contractions appear to provide greater pain relief immediately after intervention. Strength of Recommendation: There is Grade B evidence from 2 level 2 randomized controlled trials and 1 level 3 randomized crossover study supporting the use of isometric and isotonic contractions to reduce patellar tendon pain for in-season athletes.

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Behnam Gholami-Borujeni, Ali Yalfani and Leila Ahmadnezhad

This study was conducted to evaluate the effects of 8-week inspiratory muscle training on activity in the ankle muscles of athletes with chronic low-back pain. A randomized controlled trial involving 45 men and women with chronic low-back pain was carried out. Electromyography activity in the tibialis anterior, peroneus longus, gastrocnemius medialis, and gastrocnemius lateralis muscles of the dominant leg was recorded. Secondary outcomes included biopsychosocial indices, such as pain, disability, anxiety and depression, fear-avoidance beliefs, and fear of (re)injury. Static and dynamic overhead squat tests showed that inspiratory muscle training decreased activity in the tibialis anterior, peroneus longus, and gastrocnemius medialis muscles. In the static single-leg squat test and the descending phase of the dynamic equivalent, such a decrease was observed in all the 4 muscles. Inspiratory muscle training significantly reduced pain severity and activity in the tibialis anterior, peroneus longus, and gastrocnemius medialis muscles during the ascending phase of the dynamic single-leg squat test. On the basis of the findings, 8 weeks of inspiratory muscle training may constitute useful rehabilitation for reducing excessive activity in ankle joint muscles and aiding chronic low-back pain recovery.

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Connor A. Burton, Robert J. Arthur, Matthew J. Rivera and Cameron J. Powden

Context: Chronic ankle instability (CAI) is one of the most common chronic conditions in the world, resulting in millions of dollars contributed to the health care system. Joint mobilizations have been shown to effectively improve patient and disease-specific impairments secondary to CAI. The ability for patients to complete an effective manual therapy intervention without the need for continuous visits to a health care provider can alleviate burdens on the health care system and improve patient satisfaction. Objective: To examine the effect of clinician-applied Maitland talocrural joint mobilization and self-mobilization (Self-Mob) on dorsiflexion range of motion (DFROM), dynamic balance, strength, and perceived function in those with CAI. Design: Single-blind randomized trial. Setting: Research laboratory. Participants: A total of 18 participants (7 males and 11 females; age = 20.78 [2.02] y, height = 67.66 [3.83] cm, limb length = 87.74 [5.05] cm) with self-reported CAI participated. Interventions: The participants received 6 interventions over a 2-week period. The participants received either Maitland grade III anterior-to-posterior talocrural joint mobilizations or weight-bearing lunge Self-Mob. Each intervention consisted of four 2-minute sets, with a 1-minute rest between sets. Main Outcome Measures: The DFROM (weight-bearing lunge), dynamic balance (Y-Balance Test), isometric strength, Foot and Ankle Ability Measure Quick, Disablement of the Physically Active modified, Fear Avoidance Beliefs Questionnaire, and Tampa Scale of Kinesiophobia-11 were measured preintervention and postintervention. Results: Dynamic balance, isometric strength, and perceived function significantly improved in both groups at postintervention. The DFROM significantly improved in the Self-Mob group. Higher individual responder rates were demonstrated within the Self-Mob group compared with clinician-applied mobilizations. Conclusions: Clinician-applied mobilizations and Self-Mobs are effective interventions for improving dynamic balance, isometric strength, and perceived function. Application of Self-Mobs can effectively improve DFROM compared with joint mobilization. Self-Mobs may be an effective intervention to incorporate into a home care plan.

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Shogo Takano, Yoshitaka Iwamoto, Junya Ozawa and Nobuhiro Kito

Context: Previous studies have reported that the incidence of patellofemoral pain in women is 2.2 times higher than that in men. Lower hip frontal dynamic joint stiffness in women may be related to the magnitude of hip adduction and internal rotation associated with patellofemoral pain. Objective: To identify sex differences in hip frontal dynamic joint stiffness and examine the relationship between hip frontal dynamic joint stiffness and hip adduction and internal rotation during gait. Design: Cross-sectional study. Setting: University campus. Participants: A total of 80 healthy volunteers (40 women and 40 men) participated in this study. Intervention(s): Kinematic and kinetic data during gait were collected using a motion capture system and force plates. Main Outcome Measures: Hip frontal dynamic joint stiffness, hip adduction, and hip internal rotation were calculated during gait. Results: Women demonstrated lower hip frontal dynamic joint stiffness than men during gait (P < .01). They also displayed decreased hip frontal dynamic joint stiffness associated with increased hip adduction (r = −.85, P < .001) and internal rotation (r = −.48, P < .001). Conversely, in men, decreased hip frontal dynamic joint stiffness was associated with increased hip adduction (r = −.74, P < .001) but not internal rotation (r = .17, P = .28). Conclusions: Sex differences between hip frontal dynamic joint stiffness and hip internal rotation during gait may contribute to the increased incidence of patellofemoral pain in women.

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Richelle M. Williams, Rachel S. Johnson, Alison R. Snyder Valier, R. Curtis Bay and Tamara C. Valovich McLeod

Context: Concussions are shown to hinder multiple health dimensions, including health-related quality of life (HRQOL), suggesting a need for a whole-person approach to assessment and treatment. Patient-reported outcome measures are one method to gather the patient’s perspective regarding their HRQOL. Objective: To evaluate perceived HRQOL using the Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale in patients throughout concussion recovery. Design: Prospective cohort, descriptive survey. Setting: There were 9 high school athletic training facilities. Participants: A total of 70 patients with diagnosed concussions (51 males, 7 females, 12 unreported; age = 15.7 [0.9] y, height = 174.6 [8.4] cm, mass = 72.8 [14.8] kg, grade = 10.0 [0.9] level). Interventions: Patient-Reported Outcomes Measurement Information System Pediatric-25 was administered at 3 days, 10 days postconcussion, and return to play (RTP). Main Outcome Measures: Patient-Reported Outcomes Measurement Information System Pediatric-25 subscale T scores and self-reported concussion history (yes/no). Results: A total of 70 patients completed the study. For the Pediatric-25 subscales, the severity of problems associated with Physical Function Mobility, Anxiety, Depression, Fatigue, and Pain Interference were highest 3 days postconcussion, decreasing at 10 days and RTP (all p < .05). No differences were found between days 3 and 10 for Peer Relationship scores, but improvements were identified at RTP (p < .05). Pediatric-25 subscale scores at the 3 measurements were not statistically associated with concussion history (all p > .05). Ceiling and floor effects were present in all subscales throughout each timepoint, except for Physical Function Mobility (14.7%), and pain interference (11.8%) at day 3 postinjury. Conclusions: Patients who had suffered a concussion improved from day 3 through RTP on multiple health domains as demonstrated through the Pediatric-25 subscales. These findings highlight the need for health care professionals to serially monitor HRQOL and social factors that may affect the patient postconcussion as part of a multifactorial assessment. Ceiling effects in high functioning adolescent athletes were present; thus, efforts should be made to identify appropriate scales for use in managing recovery in athletic populations.

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Marcin Straczkiewicz, Nancy W. Glynn, Vadim Zipunnikov and Jaroslaw Harezlak

Background: The increasing popularity of wrist-worn accelerometers introduces novel challenges to the research on physical activity and sedentary behavior. Estimation of body posture is one such challenge. Methods: The authors proposed an approach called SedUp to differentiate between sedentary (sitting/lying) and standing postures. SedUp is based on the logistic regression classifier, using the wrist elevation and the motion variability extracted from raw accelerometry data collected on the axis parallel to the forearm. The authors developed and tested our method on data from N = 45 community-dwelling older adults. All subjects wore ActiGraph GT3X+ accelerometers on the left and right wrist, and activPAL was placed on the thigh in the free-living environment for 7 days. ActivPAL provided ground truth about body posture. The authors reported SedUp’s classification accuracy for each wrist separately. Results: Using the data from the left wrist, SedUp estimated the standing posture with median true positive rate = 0.83 and median true negative rate = 0.91. Using the data from the right wrist, SedUp estimated the standing posture with median true positive rate = 0.86 and median true negative rate = 0.93. Conclusions: SedUp provides accurate classification of body posture using wrist-worn accelerometers. The separate validation for each wrist allows for the application of SedUp in a wide spectrum of free-living studies.

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Justin B. Hollander, Ann Sussman, Peter Lowitt, Neil Angus and Minyu Situ

Background: Understanding more about the unseen side of our responses to visual stimuli offers a powerful new tool for transportation planning. Traditional transportation planning tends to focus on the mobility of vehicles rather than on opportunities to encourage sustainable transport modes, like walking. Methods: Using eye-tracking emulation software, this study measured the unconscious visual responses people have to designs and layouts in new built environments, focusing on what makes streets most walkable. Results: The study found key differences between the way the brain takes in conventional automobile-oriented residential developments versus new urbanist layouts, with the former lacking key fixation points. Conclusion: The study’s discoveries significantly explain why new urbanist layouts promote walking effortlessly and conventional automobile-oriented residential developments cannot.

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Gashaw Abeza, Jessica R. Braunstein-Minkove, Benoit Séguin, Norm O’Reilly, Ari Kim and Yann Abdourazakou

This study explored the practices and strategies of ambush marketing via social media (SM) during the 2014 Sochi, 2016 Rio, and 2018 PyeongChang Olympic Games. An observational netnography method was adopted to investigate direct industry competitors’ (of the Olympic sponsors) use of SM for the purpose of ambush marketing during the 2014, 2016, and 2018 Games. Data were gathered from the official Twitter accounts of 15 direct industry competitors over the three most recent Games. Despite a series of SM guidelines released by IOC for the 2014, 2016, and 2018 Games, the findings showed that the practice of ambush marketing via SM was evident during each of the Games. Direct industry competitors were found employing four specific ambush strategies, namely, associative, values, coattail, and property infringement. Theoretical and practical implications, as well as an impetus for future research, are suggested.

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Inge Milius, Wade D. Gilbert, Danielle Alexander and Gordon A. Bloom

There is a growing body of research on positive tactile communication and its impact on athlete performance and team dynamics. The purpose of the present study was to examine the profile and perceived impact of positive tactile communication as a coaching strategy in a high-performance team sport setting. Participants were members of a successful American collegiate women’s basketball team comprising the head coach, associate head coach, and 16 student-athletes. Methods of data collection included systematic observation and focus groups. Positive tactile communication was perceived to be an effective coaching strategy for enhancing relationships and athlete performance. To our knowledge, this is the first study to include both quantitative and qualitative data from multiple coaches on the same team, as well as athlete perceptions of coaches’ strategic use of positive tactile communication.