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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.

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Nicole T. Gabana, Jeffrey B. Ruser, Mariya A. Yukhymenko-Lescroart, and Jenelle N. Gilbert

A holistic, multicultural approach to student-athlete mental health, well-being, and performance promotes the consideration of spiritual and religious identities in counseling and consultation. Preliminary research supports the interconnectedness of spirituality, religiosity, and gratitude in athletes; thus, this study sought to replicate Gabana, D’Addario, Luzzeri, and Soendergaard's study (2020) and extend the literature by examining a larger, independently sampled, more diverse data set and multiple types of gratitude. National Collegiate Athletic Association Division I–III student-athletes (N = 596) were surveyed to better understand how religious and spiritual identity related to trait, general-state, and sport-state gratitude. Results supported past research; athletes who self-identified as being both spiritual and religious reported greater dispositional (trait) gratitude than those who self-identified as spiritual/nonreligious or nonspiritual/nonreligious. Between group differences were not found when comparing general-state and sport-state gratitude. Findings strengthen and extend the understanding of spirituality, religion, and gratitude in sport. Limitations, practical implications, and future directions are discussed.

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James E. Kaishian and Regina M. Kaishian

The physical impacts of overtraining, sport specification, and burnout are well documented in the literature; however, the state of the student-athlete’s (SA’s) mental health is something that needs to be investigated more comprehensively. Literature on SA mental health has gained prevalence within the last 5 years. The combination of pressure from sport and academics, as well as the stigmatization of clinical mental health treatment, can have a significant effect on the SA’s psyche. This review explores the prevalence of mental health conditions (MHCs) in high school and collegiate SAs. This includes signs and symptoms of mental health diagnoses to include substance- and alcohol-related addictive disorders and risk factors of such. A systematic review of the CINAHL, ERIC, SPORTDiscus, APA PsycINFO, and Rehabilitation & Sports Medicine resource databases was conducted. The initial search yielded 855 results. Following double screening, 22 studies were included, all of which were deemed medium to high quality. The findings indicate an alarming presence of MHCs ranging from risk factors of alcohol use and major depressive disorders among SAs. There was a high prevalence of mental health issues among SAs who are Black, Indigenous, people of color (BIPOC), and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ). In most cases, participation in competitive athletics (varsity) did not contribute to additional MHCs for SAs. Sport psychologists should play a role in mental health programming within athletic departments. Athletic departments should develop proactive, targeted strategies to address MHCs for SAs.