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Toshiaki Soga, Taspol Keerasomboon, Kei Akiyama, and Norikazu Hirose

Context: This study aimed to examine the differences in electromyographic (EMG) activity of the biceps femoris long head (BFlh) and semitendinosus (ST) muscles, break-point angle (BPA), and the angle at peak BFlh EMG activity between bilateral and unilateral Nordic hamstring exercise (NHE) on a sloped platform. Design: This study was designed as a case-control study. Methods: Fourteen men participated in the study. The participants initially performed maximum voluntary isometric contraction (MVIC) on the prone leg curl to normalize the peak hamstring EMG amplitude as the %MVIC. Then, participants were randomized to perform the following 3 variations of NHE: bilateral (N40) or unilateral (N40U) NHE with a platform angle of 40°, and unilateral NHE with a platform angle of 50° (N50U). The EMG activities of the BFlh and ST and the knee flexion angle during the NHE variations were recorded to calculate the EMG activity of the BFlh and ST in terms of the %MVIC, the angle at peak BFlh EMG, and BPA. Results: The BFlh %MVIC was significantly higher in N40U (P < .05) and N50U (P < .05) than in N40. A significant difference in BFlh %MVIC and ST %MVIC was observed between N40U (P < .05) and N50U (P < .05). The mean values of BPA and the angle at peak BFlh EMG were <30° for all NHE variations. Conclusions: In the late swing phase of high-speed running, BFlh showed higher EMG activity; thus, unilateral NHE may be a specific hamstring exercise for hamstring injury prevention.

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Eugene Tee, Jack Melbourne, Larissa Sattler, and Wayne Hing

Context: Acute lateral ankle sprain (LAS) is a common injury in athletes and is often associated with decreased athletic performance and, if treated poorly, can result in chronic ankle issues, such as instability. Physical performance demands, such as cutting, hopping, and landing, involved with certain sport participation suggests that the rehabilitation needs of an athlete after LAS may differ from those of the general population. Objective: To review the literature to determine the most effective rehabilitation interventions reported for athletes returning to sport after acute LAS. Evidence Acquisition: Data Sources: Databases PubMed, Embase, CINAHL, SPORTDiscus, and PEDro were searched to July 2020. Study Selection: A scoping review protocol was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines and registered (https://osf.io/bgek3/). Study selection included published articles on rehabilitation for ankle sprain in an athletic population. Data Extraction: Parameters included athlete and sport type, age, sex, intervention investigated, outcome measures, measurement tool, and follow-up period. Data Synthesis: A qualitative synthesis for all articles was undertaken, and a quantitative subanalysis of randomized controlled trials and critical methodological appraisal was also conducted. Evidence Synthesis: A total of 37 articles were included in this review consisting of 5 systematic and 20 narrative reviews, 7 randomized controlled trials, a single-case series, case report, position statement, critically appraised topic, and descriptive study. Randomized controlled trial interventions included early dynamic training, electrotherapy, and hydrotherapy. Conclusions: Early dynamic training after acute LAS in athletes results in a shorter time to return to sport, increased functional performance, and decreased self-reported reinjury. The results of this scoping review support an early functional and dynamic rehabilitation approach when compared to passive interventions for athletes returning to sport after LAS. Despite existing research on rehabilitation of LAS in the general population, a lack of evidence exists related to athletes seeking to return to sport.

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Stephanie Wise and Jordan Bettleyon

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.

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Masahiro Kuniki, Yoshitaka Iwamoto, Daiki Yamagiwa, and Nobuhiro Kito

Context: Core stability is important for preventing injury and improving performance. Although various tests for evaluating core stability have been reported to date, information on their relationship and the effect of gender differences is limited. This study aimed to (1) identify correlations among the 3 core stability tests and to examine the validity of each test and (2) identify gender differences in the test relationship and determine whether gender influenced test selection. Design: Cross-sectional study. Methods: Fifty-one healthy volunteers (27 men and 24 women) participated in the study. The participants underwent the following 3 tests: Sahrmann Core Stability Test (SCST), the lumbar spine motor control tests battery (MCBT), and Y Balance Test (YBT). Each parameter was analyzed according to all parameters and gender using the Spearman rank correlation coefficient. Results: Overall, there was a strong positive correlation between SCST and MCBT and moderate positive correlations between SCST and YBT and between MCBT and YBT. Conversely, gender-specific analyses revealed no significant correlations between YBT and SCST and between YBT and MCBT in women, although significantly strong correlations were found among all tests in men. Conclusion: Although these 3 tests evaluated interrelated functions and may be valid as core stability tests, the results should be carefully interpreted when performing YBT in women.

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Edmond J. Dixon, Christian R. Sánchez De La Cruz, and Ashley L. Artese

Context: Handheld dynamometry is a feasible, reliable, and cost-effective method for assessing shoulder strength. One limitation to this tool is the lack of standardized testing protocols and specified shoulder strength test positions. Although it is recommended that strength tests be performed in a gravity-eliminated position, this may not always be a feasible or practical testing protocol. There is limited research on the influence of gravity on strength measures; to our knowledge, no study has compared handheld dynamometry shoulder strength assessments based on body position and gravity. Therefore, the purpose of this study was to compare shoulder flexion, extension, and abduction strength assessed via handheld dynamometry between a gravity-eliminated and a gravity-influenced test position. Design: This study was a comparison of shoulder strength based on test position. The test position was the independent variable, and the dependent variables were shoulder flexion, extension, and abduction strength. Methods: Supine (gravity-eliminated) and seated (gravity-influenced) strength measures were assessed in 20 healthy adults (19.4 [1.2] y) on the dominant arm. Paired t tests were used to determine differences between body positions for each test. Significance was accepted at P ≤ .05. Results: There were no differences between supine and seated flexion and extension measures. Absolute supine shoulder abduction scores (152.5 [58.4] N) were significantly higher than seated scores (139.9 [55.6] N). Conclusions: Findings show that gravity should be considered when using handheld dynamometry scores as indicators of abductor shoulder strength and function.

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Rachel E. Brinkman-Majewski and Windee M. Weiss

Context: Athletic trainers influence the motivational climate in rehabilitation, but little is known about the role of the motivational climate on patient outcomes. The purpose of this study was to investigate the influence of the motivational climate in rehabilitation on athletes’ behaviors in rehabilitation (eg, effort and energy) and overall satisfaction with rehabilitation. Design: Cross-sectional, descriptive research. Methods: A total of 78 male and female, NCAA Division II injured athletes receiving rehabilitation services, and 7 certified athletic trainers, and 8 athletic training students providing rehabilitation health care participated. All injured athletes completed an adapted version of the Perceived Motivational Climate in Sport Questionnaire 2 to measure perceptions of the motivational climate in rehabilitation, along with the Overall Satisfaction with Rehabilitation Scale. Athletic trainers and athletic training students completed a training behaviors assessment to rate the athletes’ energy, effort, and persistence in rehabilitation. Results: Injured athletes’ perceptions of the motivational climate predicted rehabilitation behaviors and patient satisfaction. Higher perceptions of having an important role in rehabilitation predicted higher rehabilitation behaviors (F 3,74 = 4.45, P < .01), while higher perceptions of unequal recognition during rehabilitation predicted lower desirable behaviors (F 3,74 = 4.90, P < .01). Higher perceptions of a mastery climate in rehabilitation predicted greater patient satisfaction (F 3,74 = 7.41, P < .001) and lower perceptions of being punished for mistakes predicted greater satisfaction (F 3,74 = 5.92, P < .001). Conclusions: Productive athlete behaviors during rehabilitation and greater patient satisfaction with rehabilitation can be expected when athletes perceive a mastery motivational climate during rehabilitation. Athletic trainers can facilitate creating a mastery motivational climate by focusing on individual improvement, putting forth high effort, and evaluating success based on personal improvement.

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Wouter Welling, Alli Gokeler, Anne Benjaminse, Evert Verhagen, and Koen Lemmink

Background: Limited information is available on the experiences of patients during rehabilitation after anterior cruciate ligament reconstruction (ACLR). Aim:The current study aimed to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Method and Design: A survey-based study with an online platform was used to identify factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. Seventy-two patients (age 27.8 [8.8] y) after ACLR participated. Data were analyzed and themes were identified by comparing categories and subcategories on similarity. Main Findings: Positive patient experiences were room for own input, supervision, attention, knowledge, honesty, and professionalism of the physiotherapist. Additionally, a varied and structured rehabilitation program, adequate facilities, and contact with other patients were identified as positive patient experiences. Negative experiences were a lack of attention, lack of professionalism of the physiotherapists, a lack of sport-specific field training, a lack of goal setting, a lack of adequate facilities, and health insurance costs. Conclusions: The current study identified factors that differentiated positive and negative patient experiences during rehabilitation after ACLR. These findings can help physiotherapists in understanding the patient experiences during rehabilitation after ACLR.

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Erik T. Hummer, Tanner Thorsen, Joshua T. Weinhandl, Jeffrey A. Reinbolt, Harrold Cates, and Songning Zhang

Patients following unilateral total knee arthroplasty (TKA) display interlimb differences in knee joint kinetics during gait and more recently, stationary cycling. The purpose of this study was to use musculoskeletal modeling to estimate total, medial, and lateral tibiofemoral compressive forces for patients following TKA during stationary cycling. Fifteen patients of unilateral TKA, from the same surgeon, participated in cycling at 2 workrates (80 and 100 W). A knee model (OpenSim 3.2) was used to estimate total, medial, and lateral tibiofemoral compressive forces for replaced and nonreplaced limbs. A 2 × 2 (limb × workrate) and a 2 × 2 × 2 (compartment × limb × workrate) analysis of variance were run on the selected variables. Peak medial tibiofemoral compressive force was 23.5% lower for replaced compared to nonreplaced limbs (P = .004, G = 0.80). Peak medial tibiofemoral compressive force was 48.0% greater than peak lateral tibiofemoral compressive force in nonreplaced limbs (MD = 344.5 N, P < .001, G = 1.6) with no difference in replaced limbs (P = .274). Following TKA, patients have greater medial compartment loading on their nonreplaced compared to their replaced limbs and ipsilateral lateral compartment loading. This disproportionate loading may be cause for concern regarding exacerbating contralateral knee osteoarthritis.

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Stephen Shannon, Mark Shevlin, and Gavin Breslin

Aim: A recent mental health in sport consensus statement advocates Keyes’ two continua model with an associated Mental Health Continuum (MHC) instrument to assess mental health in athletes. However, there remains statistically inconsistent usage of the MHC in athletes, so further exploration of the MHC’s psychometric factors is required. Methods: Athletes (N = 1,097) aged 32.63 (SD = 11.16) comprising 603 females (55.7%) and 478 males (44.3%), completed the 14-item MHC-Short Form, alongside validated measures of anxiety and depression. Five confirmatory factor analytic and bifactor models were developed based on extant research and theory. Results: Overall, a bifactor structure with a “general” positive mental health factor, and three specific factors (“hedonic well-being,” “social well-being,” and “psychological well-being”) fitted the data well and was deemed the superior model. Conclusion: A bifactor model of the MHC-Short Form is recommended comprising a composite score alongside specific factors of hedonic, social, and psychological well-being.