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Erin Frey, Kayla Ruszin, and Emily E. Hildebrand

Focused Clinical Question: Does the application of kinesiotape compared with standard treatments result in greater/faster postoperative edema reduction after total knee replacement or anterior cruciate ligament repair?Clinical Bottom Line: There was sufficient evidence to support the application of kinesiotape to reduce postoperative edema brought on by a total knee replacement or anterior cruciate ligament repair. Patients who received kinesiotaping, applied to the skin with a pattern to enhance lymphatic drainage, showed significant decreases in postoperative knee circumference measurements and pain levels. Kinesiotaping application under these acute conditions offers an evidence-based approach for clinicians to optimize the physiological environment and promote progress through a patient’s phases of healing.

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Shayane Santiago, Moni Syeda, Jason Bartholomew, and Russell T. Baker

Focused Clinical Question: What are the effects of the Mulligan Concept combined with traditional physiotherapy on lateral elbow pain and grip strength in adults with lateral epicondylalgia (LE) compared with traditional physiotherapy? Clinical Bottom Line: Grade B evidence supports positive effects of the Mulligan Concept combined with traditional physiotherapy on LE compared with traditional physiotherapy alone. However, the effects of the Mulligan Concept as a standalone intervention in the treatment of LE are not well known. Therefore, additional research is warranted to determine the individual effects of the Mulligan Concept compared with its use in a comprehensive rehabilitation protocol to treat LE in adults.

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Bryan L. Riemann and George J. Davies

Context: Typically, most clinical return to activity guidelines recommend that an injured shoulder achieve a 90% to 100% functional performance test limb symmetry index (LSI); however, as previous research demonstrated a 103% to 111% dominant limb bias in seated single-arm shot-put test (SSASPT) performance, the typical criteria might not be appropriate for interpreting SSASPT LSI. Thus, the current objective was to evaluate SSASP LSI differences between dominant and nondominant involved shoulders and to determine how many patients met the suggested 90% to 100% LSI criteria, as well as the 103% for dominant (89% for nondominant) normative SSASPT threshold reported in the literature, at the time of discharge. Design: Cross-sectional. Methods: Patients with shoulder injury or surgery (n = 78) completed the SSASPT at the time of discharge from rehabilitation and were grouped according to whether the involved shoulder was the dominant (n = 42) or nondominant (n = 32) limb. LSI (involved/uninvolved × 100) was computed from the average of 3 SSASPT trial distances completed with each limb. Results: The LSI for the nondominant involved group (88.9% [12.4%]) was significantly less (confidence intervalDiff, −12.1% to −22.1%) than the dominant involved group (106.0% [9.3%]). While 95.2% of patients in the dominant involved group exhibited LSI > 90%, only 43.8% of patients in the nondominant involved group attained LSI > 90%. Across the entire cohort, the odds of a nondominant involved LSI being below the respective SSASPT normative range were 2.04 (95% confidence interval, 0.80–5.21) times higher than the odds of a dominant involved LSI being below the normative range. Conclusions: Patients with dominant limb involvement exhibited higher LSI than patients with nondominant limb involvement at discharge from rehabilitation. Particularly when the nondominant shoulder is involved, these results suggest that patients with shoulder injury and surgery may require longer rehabilitation to attain higher levels of upper-extremity function.

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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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Lee T. Atkins, Michael Lowrey, Sarah Reagor, Kirsten Walker, and Dhalston Cage

Research indicates that increasing trunk flexion may optimize patellofemoral joint loading. However, this postural change could cause an excessive Achilles tendon force (ATF) and injury risk during movement. This study aimed to examine the effects of increasing trunk flexion during stair ascent on ATF, ankle biomechanics, and vertical ground reaction force in females. Twenty asymptomatic females (age: 23.4 [2.5] y; height: 1.6 [0.8] m; mass: 63.0 [12.2] kg) ascended stairs using their self-selected and flexed trunk postures. Compared with the self-selected trunk condition, decreases were observed for peak ATF (mean differences [MD] = 0.14 N/kg; 95% confidence interval [CI], 0.06 to 0.23; Cohen d = −1.2; P = .003), average rate of ATF development (MD = 0.25 N/kg/s; 95% CI, 0.07 to 0.43; Cohen d = −0.9; P = .010), ankle plantar flexion moment (MD = 0.08 N·m/kg; 95% CI, 0.03 to 0.13; Cohen d = −1.1; P = .005), and vertical ground reaction force (MD = 38.6 N/kg; 95% CI, 20.3 to 56.90; Cohen d = −1.8; P < .001). Increasing trunk flexion did not increase ATF. Instead, this postural change was associated with a decreased ATF rate and magnitude and may benefit individuals with painful Achilles tendinopathy.

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Chris J. Alfiero, Ann F. Brown, Youngmin Chun, Alexandra Holmes, and Joshua P. Bailey

The purpose of this study was to investigate the effects of foot positioning and lean mass on jumping and landing mechanics in collegiate dancers. Thirteen dancers performed 3 unilateral and bilateral vertical jumps with feet in neutral and turnout positions. Dual-energy x-ray absorptiometry scans, jump height, vertical stiffness, and joint stiffness were assessed for relationships between foot positions. Jump heights were greater in right compared with left limb (P = .029) and neutral compared with turnout (P = .020) during unilateral jumping. In unilateral landing, knee stiffness was greater in turnout compared with neutral (P = .004) during the loading phase. Jump height (P < .001) was significantly increased, and vertical stiffness (P = .003) was significantly decreased during bilateral jumping in neutral compared with turnout. Significantly increased hip stiffness during the attenuation phase was observed in neutral compared with turnout (P = .006). Left-limb lean mass was significantly less than the right limb (P < .05). Adjustments for bilateral jumping were focused on hip stiffness, whereas there was a slight shift to knee strategy for unilateral jump.

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Rodrigo Ghedini Gheller, Rafael Lima Kons, Juliano Dal Pupo, and Daniele Detanico

The aim of this systematic review was to investigate the effect of specific sprint and vertical jump training interventions on transfer of speed–power parameters. The data search was carried out in three electronic databases (PubMed, SCOPUS, and SPORTDiscus), and 28 articles were selected (13 on vertical jump training and 15 on sprint training). We followed the PRISMA criteria for the construction of this systematic review and used the Physiotherapy Evidence Database (PEDro) scale to assess the quality of all studies. It included studies with a male population (athletes and nonathletes, n = 512) from 18 to 30 years old who performed a vertical jump or sprint training intervention. The effect size was calculated from the values of means and SDs pre- and posttraining intervention. The percentage changes and transfer of training effect were calculated for vertical jump training and sprint training through measures of vertical jump and sprint performance. The results indicated that both training interventions (vertical jump training and sprint training) induced improvements in vertical jump and linear sprint performance as well as transfer of training to speed–power performance. However, vertical jump training produced greater specific and training transfer effects on linear sprint than sprint training (untrained skill). It was concluded that vertical jump training and sprint training were effective in increasing specific actions of vertical jump and linear sprint performance, respectively; however, vertical jump training was shown to be a superior alternative due to the higher transfer rate.

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Carlos Alix-Fages, Jozo Grgic, Pablo Jiménez-Martínez, Eneko Baz-Valle, and Carlos Balsalobre-Fernández

The purpose of the present systematic review and meta-analysis was to explore the effects of mental fatigue on upper and lower body strength endurance. Searches for studies were performed in the PubMed/MEDLINE and Web of Science databases. We included studies that compared the effects of a demanding cognitive task (set to induce mental fatigue) with a control condition on strength endurance in dynamic resistance exercise (i.e., expressed as the number of performed repetitions at a given load). The data reported in the included studies were pooled in a random-effects meta-analysis of standardized mean differences. Seven studies were included in the review. We found that mental fatigue significantly reduced the number of performed repetitions for upper body exercises (standardized mean difference: −0.41; 95% confidence interval [−0.70, −0.12]; p = .006; I 2 = 0%). Mental fatigue also significantly reduced the number of performed repetitions in the analysis for lower body exercises (standardized mean difference: −0.39; 95% confidence interval [−0.75, −0.04]; p = .03; I 2 = 0%). Our results showed that performing a demanding cognitive task—which induces mental fatigue—impairs strength endurance performance. Collectively, our findings suggest that exposure to cognitive tasks that may induce mental fatigue should be minimized before strength endurance-based resistance exercise sessions.

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Andrew R. Gallucci, Ashlyne Elliott, Leslie Oglesby, Kristina White, and Katie Richardson

Grit is a construct measuring increased perseverance for long-term goals. Research suggests that healthcare students with higher grit scores perform better academically and professionally. Grit has not been assessed in athletic training students. A total of 756 athletic training students completed the survey. Over 90% of students intended to work as an athletic trainer. Grit was a predictor of a student’s intention to practice as an athletic trainer. Females and graduate students were also more likely to enter the field of athletic training. A student’s grit score could help predict their intention to practice as an athletic trainer.