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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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Daniel Viggiani and Jack P. Callaghan

Viscoelastic creep generated in the lumbar spine following sustained spine flexion may affect the relationship between tissue damage and perceived pain. Two processes supporting this altered relationship include altered neural feedback and inflammatory processes. Our purpose was to determine how low back mechanical pain sensitivity changes following seated lumbar spine flexion using pressure algometry in a repeated-measures, cross-sectional laboratory design. Thirty-eight participants underwent a 10-minute sustained seated maximal flexion exposure with a 40-minute standing recovery period. Pressure algometry assessed pressure pain thresholds and the perceived intensity and unpleasantness of fixed pressures. Accelerometers measured spine flexion angles, and electromyography measured muscular activity during flexion. The flexion exposure produced 4.4° (2.7°) of creep that persisted throughout the entire recovery period. The perception of low back stimulus unpleasantness was elevated immediately following the exposure, 20 minutes before a delayed increase in lumbar erector spinae muscle activity. Women reported the fixed pressures to be more intense than men. Sustained flexion had immediate consequences to the quality of mechanical stimulus perceived but did not alter pressure pain thresholds. Neural feedback and inflammation seemed unlikely mechanisms for this given the time and direction of pain sensitivity changes, leaving a postulated cortical influence.

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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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Chia-Cheng Lin, Sunghan Kim, Paul DeVita, Matt Becker, and Stacey Meardon

This study aimed to examine the feasibility of using time-to-contact measures during the perturbation protocol in people with diabetes mellitus. Three-dimension motion capture and force data were collected during 0.5-s perturbations in four directions (forward, backward, right, and left) and at two accelerations (20 and 40 cm/s2) to compute the time-to-contact. Time-to-contact analysis was divided into three phases: perturbation, initial recovery, and final recovery. The statistical analysis showed the main effects of Direction and Phase (p < .01) as well as a Direction by Phase interaction (p < .01). Backward perturbation with lower acceleration and backward/forward perturbation with higher acceleration had deleterious effects on postural stability in people with diabetes mellitus.

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Jason Kostrna and Aaron D’Addario

The mindful sport performance enhancement (MSPE) protocol is designed to enhance mindfulness, emotional regulation, and attentional awareness and control. The MSPE consists of trainer led group sessions teaching the concepts of mindfulness through discussion and meditation practice. However, little research has tested the MSPE protocol’s adaptability and generalizability to National Collegiate Athletic Association (NCAA) Division-I teams and practitioners independent of the MSPE protocol’s creators. Therefore, the aim of the present study was to test the efficacy of an adapted MSPE protocol. The adapted MSPE protocol was delivered to a NCAA Division I team while a second team participated as a potentially equivalent control group. Both teams completed measures of attentional control, flow, rumination, and mindful attention as primary outcome variables. Results revealed significant decreases in rumination and trait anxiety, as well as improvements in concentration control and focusing ability compared with the control group. Findings support the external validity of the MSPE protocol to adapt to independent practitioners and a previously unstudied combination of sport and level of competition.

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Kebin Shen and Yunxi Liu

Age-, height- and weight-matched children were recruited to the experimental group (EG; n = 31) and control group (n = 32). Following a 16-week soccer training program, balance ability and dominant-side lateral knee and ankle kinesthesia changes were tested. Regarding balance ability, the Sway Index, when children stood on a firm or foam surface with their eyes closed in the static balance test, and the dynamic balance test time were 13.5%, 11.6%, and 14.3% lower in the EG than in the control group, respectively. The scores in the left and right directions were 23.7% and 24.2% higher in the EG, respectively. Regarding kinesthesia, the angle of knee extension and ankle metatarsal flexion and dorsiflexion were 13.4%, 20.0%, and 16.8% lower in the EG than in the control group. These results indicate children in the EG had a better performance. After soccer exercise, children aged 5–6 years displayed improved balance in the left and right directions and improved knee extension, ankle plantarflexion, and dorsiflexion kinesthesia.

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Precious Barnes and Matthew Rivera

Context: Active Release Technique® (ART®) is a manual therapy used for soft tissue-related issues, commonly used to lengthen structures in a shortened position and to restore motion of soft tissues. Objective: The purpose of this systematic review was to collect, appraise, and summarize the available literature, evaluating the effects of ART® on pain, range of motion (ROM), and disability. Evidence Acquisition: Electronic databases (PubMed, EBSCOhost, MEDLINE, SPORTDiscus, and CINAHL) were searched from 2000 to November 2020. The search was completed using a combination of key words related to ART®, rehabilitation, and outcomes. Search limits were full-text publications written in English. Inclusion criteria required that studies evaluated outcomes using ART® for rehabilitation, were peer reviewed, and included human participants without catastrophic conditions or injuries. The modified Downs and Black checklist for nonrandomized studies was used to assess methodological quality of identified studies by 2 independent reviewers, average scores were calculated. The level of evidence was assessed using the strength of recommendation taxonomy. Evidence Synthesis: Nine studies were inculded in this review. The average methodological quality of the studies was 12/15 and ranged from 10 to 14, with the most common methodological quality item missed being the blinding of researchers collecting outcomes. Six studies that assessed pain found significant improvements in participants’ pain levels. Six studies that assessed ROM found significant improvement in participants’ ROM. Two studies that assessed disability found significant improvement in disability. Conclusion: Evidence suggests that ART® may be beneficial in improving pain, ROM, and disability. This review found that ART® positively impacted patient outcomes and may be a viable treatment option for clinicians treating musculoskeletal conditions. However, further research is necessary to determine optimal dosage and long-term effects of ART® on these patient outcomes.