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The stiffness of the supporting leg may alter the energy transfer to the trunk and lower extremities of the kicking leg, which may affect kick performance. This study aimed to clarify whether the stiffness of the supporting leg affects the trunk kinematics during kicking and kicking performance in soccer players. Twenty-two male collegiate soccer players participated in the study. The data for the stiffness properties of the supporting leg and trunk kinematics were obtained and calculated using a 3-dimensional motion analysis system. The results showed that a greater leg stiffness of the supporting leg was associated with a lower trunk rotation angle during kicking. There were no significant correlations between the maximum swing speed and the stiffness of the supporting leg (P < .05). These results suggest that stiffness of the supporting leg may restrain trunk rotation during the kicking motion. However, the lack of a relationship with swing speed indicates the need for further investigation into its effects on kicking performance.

Context: Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. Case Presentation: A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. Management and Outcome: After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. Conclusion: Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.

Objective: To culturally adapt and validate the Italian version of the Shoulder Instability—Return to Sport after Injury (SI-RSI-I) scale. Methods: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament—Return to Sport Index—Italian version and replacing the term “knee” with “shoulder.” Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test–retest reliability, measurement error, and construct validity. Results: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α = .935), and excellent test–retest reliability (ICC = .926; 95% CI, .853–.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. Conclusion: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI.

This study investigated the effects of two physical exercise programs for adults with intellectual and developmental disabilities. Twenty-one participants were assigned to an indoor group (IG, n = 7; 24-week gym intervention with machine), an outdoor group (OG, n = 7; 24-week outdoor intervention with low-cost materials) or a control group. The outcomes assessed included quality of life, dementia, and functional capacity. The IG significantly improved physical well-being compared with the control group (p = .017). There were no significant differences in dementia score between groups and moments. Postintervention, the IG showed improvements compared with the control group for the 30-s sit-to-stand test (p = .03), timed up-and-go (p = .00), and 6-min-walk test (p = .033) and between moments in the IG for 30-s sit-to-stand test (pre ≠ post; p = .007) and 6-min-walk test (pre ≠ post; p = .007). Outdoor interventions appeared effective for physical well-being, while indoor interventions using weight-training machines benefited functional capacity. No significant effects were observed for dementia/cognitive decline.

Context: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. Design: Scoping review. Methods: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. Results: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. Conclusion: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development.

Context: Proprioceptive neuromuscular facilitation stretching (PNFS) is suggested to improve the range of motion and flexibility as an active warm-up. Recently, the foam rolling (FR) methods have also emerged as a passive warm-up. However, the combined effects of PNFS and FR are still unclear, and no reports have compared their effects using thermal imaging. This study investigated the acute effects of combining nonvibration FR (NVFR) and vibration FR (VFR) prior to PNFS, in comparison with PNFS alone, on hamstring flexibility and thigh skin temperature. Design: Randomized controlled trial. Methods: Participants (n = 60) were randomly assigned to PNFS, NVFR + PNFS, VFR + PNFS, and control group (CG). Active knee-extension (AKE), sit and reach (SR) test, and thermal imaging were evaluated before (pre-int), immediately after (post-int), and 30-minutes after (post₃₀-int) intervention. Results: All intervention groups had a significant increase at all time periods (P < .001) except the CG in terms of AKE and sit and reach test (P > .05). Combined (NVFR + PNFS/VFR + PNFS) groups had also a significant increase in the post₃₀-int compared with pre-int and post-int values of thigh skin temperature (P < .001). Combined groups, over time, had the best post₃₀-int effect on increasing skin temperature. The study found a significant interaction effect between interventions and time across several measurements (P < .05). Combined groups showed more significant improvements in AKE compared to CG at post-int (P < .05). There is a similar change in AKE, SR test, and skin temperatures between combined groups and PNFS alone at both post-int and post₃₀-int (P < .05). Conclusions: These findings indicate that using FR, with or without vibration, before PNFS does not provide an additional benefit in improving hamstring flexibility and thigh skin temperatures compared with PNFS alone.

Context: General screening methods for athletes are limited. This study aims to analyze the reliability and validity of the Japanese version of the athlete sleep screening questionnaire. Methods: In total, 111 female collegiate athletes completed the initial test and retest. The independent variables included the kind of sports of the participants and their athletic level, grade (freshman, sophomore, junior, and senior), and age. The reliability of the questionnaire was assessed using Cronbach’s alpha and intraclass correlation coefficients. Athletes competing in team sports and individual sports were compared to evaluate for differences. Results: A total of 38.7% of athletes had moderate to severe sleep difficulty score. Their Cronbach’s alpha for test and retest were .34 and .44, respectively. The intraclass correlation coefficient indicated sufficient internal consistency and test–retest validity. The mean sleep difficulty scores were 7.0 (2.3) and 6.5 (2.1) for test and retest, but no significant difference was observed between the individual and team sport athletes. Results of multivariable regression analysis revealed that having sleep and performance issues during travel was related to sleep difficulty scores (Coef 1.44, P < .01). Conclusions: Athletes of all levels have sleep disorders. The Japanese version of athlete sleep screening questionnaire has been validated with sufficient test–retest validity but has poor internal consistency. Thus, although Japanese version of the athlete sleep screening questionnaire is an appropriate questionnaire for assessing sleep disorders in athletes whose primary language is Japanese, future research is needed to optimize the questionnaire accounting for cultural variation.

Clinical Scenario: Patella dislocation is a common knee injury resulting in decreased function, increased knee pain, and a higher risk of recurrent patella dislocation. Patients with patella instability are treated surgically or conservatively with physical therapy to minimize redislocation risk and restore function. Clinical Question: In individuals with a patella dislocation, how does treatment (conservative therapy versus medial patellofemoral ligament [MPFL] surgery) affect redislocation rates and patient-perceived function? Summary of Key Findings: This critically appraised topic included 3 studies assessing outcomes in individuals with patella instability treated with MPFL surgery or conservative management. Outcomes included comparing redislocation rates and Kujala scale perceived knee function between participant groups. Surgery included MPFL reconstruction (MPFL-R) in 1 randomized controlled trial and 1 prospective controlled trial and MPFL repair in another randomized controlled trial. Conservative treatment included physical therapy and bracing. All 3 studies demonstrated significantly lower redislocation rates in individuals managed with surgery versus conservative treatment. Reported knee function was significantly higher in the MPFL-R group compared with individuals conservatively managed at 2-year follow-up but not at 1 year. No significant difference in knee function was present between individuals receiving MPFL repair or conservative management at a 2-year follow-up. Clinical Bottom Line: There is moderate-level evidence to support a significant decrease in patella redislocation rates in individuals managed with MPFL surgery compared with conservative treatment. The reviewed studies suggest a significant improvement in patient-perceived knee function at 2 years following MPFL-R but no difference at 1 year following MPFL-R or 2 years after MPFL repair. Strength of Recommendations: Grade B evidence supports lower patella redislocation rates with MPFL surgery compared with nonsurgical treatment. Furthermore, this evidence suggests a potential benefit in perceived knee function 2 years after MPFL-R compared with conservative management.

Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of >48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient’s mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B.