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Danielle Peers, Lindsay Eales, Kelvin Jones, Aidan Toth, Hernish Acharya, and Janice Richman–Eisenstat

The purpose of this study was to assess the safety and meaningfulness of a 15-week recreational dance and singing program for people with neuromuscular conditions. Within a transformative mixed-methods design, pulmonary function tests, plethysmography through wearable technology (Hexoskin vests), individualized neuromuscular quality-of-life assessments (version 2.0), and semistructured interviews were used. The interviews were analyzed through inductive, semantic thematic analysis. Although the sample sizes were small (six people with neuromuscular conditions), the authors found no evidence of safety concerns. There was evidence of respiratory improvements and reported improvements in swallowing and speech. The most notable quality-of-life changes included improvements related to weakness, swallowing, relationships, and leisure. The participants shared that the program offered meaningful social connection and embodied skills and safe and pleasurable physical exertion. The authors learned that recreational singing and dancing programs could be a safe and deeply meaningful activity for those with neuromuscular conditions that impact respiration.

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Rachel R. Kleis, Matthew C. Hoch, Deirdre Dlugonski, and Johanna M. Hoch

Patients with a history of anterior cruciate ligament reconstruction (ACLR) report decreased levels of physical activity participation, which can result in a significant public health burden. Psychosocial factors, such as fear of reinjury and decreased self-efficacy, negatively impact physical activity levels in this population. However, factors such as attitudes and beliefs toward exercise, motivation, self-efficacy, and social support are known to positively influence physical activity participation. The Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) incorporate such constructs and have been utilized to predict and improve physical activity behaviors in a variety of populations. Emerging evidence has applied the TPB and SDT to rehabilitation adherence in populations with musculoskeletal injury and post-ACLR. However, we believe a combination of the TPB and SDT will provide a framework for increasing physical activity engagement for people with a history of ACLR. The purpose of this review is to present an integrated theoretical model that combines the TPB and SDT with the aim of increasing physical activity after ACLR. Recommendations for future research and clinical practice based on the proposed model are also discussed.

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Rachel K. Straub, Alex Horgan, and Christopher M. Powers

Given that increased use of the knee extensors relative to the hip extensors may contribute to various knee injuries, there is a need for a practical method to characterize movement behavior indicative of how individuals utilize the hip and knee extensors during dynamic tasks. The purpose of the current study was to determine whether the difference between sagittal plane trunk and tibia orientations obtained from 2D video (2D trunk–tibia) could be used to predict the average hip/knee extensor moment ratio during athletic movements. Thirty-nine healthy athletes (15 males and 24 females) performed 6 tasks (step down, drop jump, lateral shuffle, deceleration, triple hop, and side-step-cut). Lower-extremity kinetics (3D) and sagittal plane video (2D) were collected simultaneously. Linear regression analysis was performed to determine if the 2D trunk–tibia angle at peak knee flexion predicted the average hip/knee extensor moment ratio during the deceleration phase of each task. For each task, an increase in the 2D trunk–tibia angle predicted an increase in the average hip/knee extensor moment ratio when adjusted for body mass (all P < .013, R 2 = .17–.77). The 2D trunk–tibia angle represents a practical method to characterize movement behavior that is indicative of how individuals utilize the hip and knee extensors during dynamic tasks.

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Adam S. Lepley and Lindsey K. Lepley

Context: Arthrogenic muscle inhibition (AMI) continues to be a limiting factor in joint rehabilitation as the inability to volitionally activate muscle significantly dampens recovery. New evidence acquired at higher brain centers and in clinical populations continues to reshape our perspective of what AMI is and how to treat it. This review aims to stimulate discussion about the far-reaching effects of AMI by exploring the interconnected pathways by which it evolves. Objectives: To discuss how reflexive inhibition can lead to adaptations in brain activity, to illustrate how changes in descending motor pathways limit our ability to contract muscle following injury, and to summarize the emerging literature on the wide-reaching effects of AMI on other interconnected systems. Data Sources: The databases PubMed, SPORTDiscus, and Web of Science were searched for articles pertaining to AMI. Reference lists from appropriate articles were cross-referenced. Conclusion: AMI is a sequential and cumulative neurological process that leads to complex clinical impairments. Originating with altered afferent information arising from an injured joint, patients experience changes in afferent information, reflexive muscle inhibition, deficiencies in somatosensation, neuroplastic compensations in higher brain centers, and ultimately decreased motor output to the muscle surrounding the joint. Other aspects of clinical function, like muscle structure and psychological responses to injury, are also impaired and influenced by AMI. Removing, or reducing, AMI should continue to be a focus of rehabilitation programs to assist in the optimization of health after joint injury.

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Lucas Ettinger, Matthew Shaprio, and Andrew Karduna

Context: Shoulder muscle activation in patients with subacromial impingement is highly cited and variable in the literature. Differences between studies could be due to artifacts introduced by normalization practices in the presence of pain. Ultimately, this lack of knowledge pertaining to pathogenesis limits the clinical treatment and restoration of muscular function. Design: A total of 21 patients with stage 2 subacromial impingement and 21 matched controls were recruited for EMG testing of their affected shoulder during an arm elevation task. The patients were tested before and after receiving an injection to their subacromial bursa. Methods: The EMG from 7 shoulder muscles were measured before and after treatment during humeral motion in the scapular plane. Results: Our findings indicate an increase in anterior deltoid, middle deltoid, and upper trapezius activity following the injection; further, this trend extended to the controls. The control subjects had a greater activation of the latissimus dorsi at peak arm elevation when compared with the patient group postinjection. Conclusions: Our results indicate that a reduction in subacromial pain is associated with changes in shoulder muscle recruitment, primarily of the deltoid. This change in deltoid activity may lend evidence to rotator cuff function in patients without rotator cuff tears.

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Jorg Teichmann, Kim Hébert-Losier, Rachel Tan, Han Wei Lem, Shabana Khanum, Ananthi Subramaniam, Wee-Kian Yeo, Dietmar Schmidtbleicher, and Christopher M. Beaven

Objective: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return to sport decisions. The authors’ objective was to assess reactive strength as a metric for informing return-to-sport decisions. Design: Case-control design. Methods: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. Results: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; −0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). Conclusion: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors’ findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for reinjury.