Abbey Thomas and Jeffrey B. Driban
Jennifer L. Rizzo
The diagnosis of thoracic outlet syndrome (TOS) is challenging and primarily determined by clinical examination. Symptoms such as numbness and tingling in the arms when raised above the head make the rehabilitation process difficult due to the various manifestations of TOS presented to the athletic trainer (AT). An AT should understand the intricate anatomical characteristics of the thoracic outlet and how various TOS presentations may impact treatment. In this clinical commentary, I provide my own insights for understanding TOS from my perspective as a patient and AT. These insights are valuable when making diagnostic, therapeutic, and prognostic clinical decisions.
Scott W. Cheatham and Russell Baker
Context: Kinesiology tape (KT) is a therapeutic intervention used to treat different musculoskeletal conditions and to enhance sports performance. The evidence is inconclusive, with researchers attributing the variable outcomes to different manufactured KT used in the research. Researchers have begun to measure and document the mechanical properties of different brands, using machines versus professionals. This prevents a clear translation to clinical practice, as it may be difficult to reproduce outcomes. There is a need to measure the mechanical properties of KT using more clinically relevant methodology. Objective: The purpose was to document a clinically relevant method of measuring the mechanical properties of 2 different types of precut RockTape® tape at common elongation lengths and to establish the methodology for future validation research on this testing method. Design: Controlled laboratory study. Setting: University laboratory. Participants: One researcher conducted all measurements. Procedures: Each tape was measured at 3 elongation lengths with a force gauge. Main Outcome Measures: Force, stress, and Young modulus. Results: The RockTape® 2 and RockTape® 3 elongation force were 25% = 2.27 (0.21) and 2.12 (0.26) N, 50% = 6.51 (0.27) and 5.93 (0.20) N, and 75% = 30.13 (0.63) and 21.23 (0.41) N. The stress values for the RockTape® 2 and RockTape® 3 were 25% = 0.88 (0.05) and 0.82 (0.03) kPa, 50% = 2.52 (0.03) and 2.29 (0.01) kPa, and 75% = 11.67 (0.04) and 8.23 (0.02) kPa. The Young modulus values for the RockTape® 2 and RockTape® 3 were 25% = 3.51 (0.00) and 3.29 (0.00) kPa, 50% = 5.04 (0.00) and 4.60 (0.00) kPa, and 75% = 15.57 (0.00) and 10.96 (0.00) kPa. Conclusion: This investigation documented a novel method of measuring the mechanical properties of 2 types of RockTape® KT. Future research should attempt to validate these testing methods.
Emily R. Hunt, Cassandra N. Parise, and Timothy A. Butterfield
Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical “control” for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.
Nickolai Martonick, Kimber Kober, Abigail Watkins, Amanda DiEnno, Carmen Perez, Ashlie Renfro, Songah Chae, and Russell Baker
Clinical Scenario: Joint instability is a common condition that often stems from inadequate muscle activation and results in precarious movement patterns. When clinicians attempt to mechanically treat the unstable joint rather than attending to the underlying cause of the instability, patient outcomes may suffer. The use of kinesiology tape (KT) on an unstable joint has been proposed to aid in improving lower-extremity neuromuscular control. Clinical Question: Does KT improve factors of neuromuscular control in an athletic population when compared with no-tape or nonelastic taping techniques? Summary of Key Findings: The current literature was searched, and 5 randomized controlled studies were selected comparing the effects of KT with no-tape or nonelastic taping techniques on lower-extremity neuromuscular control in an athletic population. Primary findings suggest KT is not more effective than no-tape or nonelastic tape conditions at improving lower-extremity neuromuscular control in a healthy population. Clinical Bottom Line: The current evidence suggests that KT is ineffective for improving neuromuscular control at the ankle compared with nonelastic tape or no-tape conditions. KT was also found to be ineffective at improving hip and knee kinematics in healthy runners and cyclists. However, preliminary research has demonstrated improved neuromuscular control in a population displaying excessive knee valgus during a drop jump landing, after the application of KT. Clinicians should be cautious of these conflicting results and apply the best available evidence to their evaluation of the patient’s status. Strength of Recommendation: There is grade B evidence that the use of KT on an athletic population does not improve biomechanical measures of ankle stability. There is inconclusive, grade B evidence that KT improves neuromuscular control at the knee in symptomatic populations.
Pedro Gómez-Carmona, Ismael Fernández-Cuevas, Manuel Sillero-Quintana, Javier Arnaiz-Lastras, and Archit Navandar
Context: Infrared thermography has been used to detect skeletal muscle overload and fatigue in athletes, but its use in injury prevention in professional soccer has not been studied to date. Objectives: To establish a novel injury prevention program based on infrared thermography and to determine its influence on the injury incidence in professional soccer players in the preseason. Design: A cross-sectional, prospective study design was used to compare a conventional injury prevention program (CPP) applied over the first preseason and an infrared thermography injury prevention program (IRTPP) carried out in the following preseason. Setting: Soccer training ground. Participants: Twenty-four players belonging to a first division soccer team from Spain. Main Outcome Measures: Injury incidences of each player were recorded according to the Orchard Sports Injury Classification System (version 10.0) convention to determine the injury classification, location, and type. Results: The incidence of injuries decreased from 15 injuries in the CPP preseason (0.63 [0.77] injuries per player) to 6 injuries in the second preseason when the IRTPP was applied (0.25 [0.53] injuries per player). The days of absence due to injuries also decreased from the CPP preseason (156 d, 10.4 [11.0] d per injury) to the IRTPP preseason (14 d, 2.3 [2.8] d per injury). The injury severity also decreased from the first preseason to the second preseason, and fewer musculoskeletal injuries in the thigh, hip, and groin were reported. Conclusions: The implementation of an IRTPP can reduce the presence of injuries by identifying players potentially at risk and as a result, reducing the injury severity and days lost as a consequence.
Ashley L. Santo, Melissa L. Race, and Elizabeth F. Teel
Context: Convergence dysfunction following concussion is common. Near point of convergence (NPC) is a quick and easy assessment that may detect oculomotor dysfunction such as convergence insufficiency (CI), but NPC measurements are rarely reported. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. Objectives: The purpose of this article was to systematically review the literature and answer the following clinical questions: (1) Is performance on NPC negatively affected in patients diagnosed with a concussion compared with pre-injury levels or healthy controls? (2) In patients diagnosed with concussion, what is the effect of oculomotor/vision therapy on NPC break measurements? Evidence Acquisition: The search was conducted in CINAHL, SPORTDiscus, MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, convergence, vision, and rehabilitation. Literature considered for review included original research publications that collected measures of NPC break in concussion patients, with a pretest–posttest comparison or comparison with a healthy control group. A literature review was completed; 242 relevant articles were reviewed, with 18 articles meeting criteria for inclusion in the review. Evidence Synthesis: Articles were categorized according to the clinical question they addressed. The patient or participant sample (number, sex, age, and health status), study design, instrumentation, or intervention used, and main results were extracted from each article. Conclusions: The authors' main findings suggest that there is a moderate level of evidence that patients have impaired NPC up to several months postconcussion, and a low level of evidence that impairments can be successfully treated with oculomotor therapy. These findings should be cautiously evaluated; the studies are limited by weak/moderate quality, small sample sizes, varied methodology, and nonrandomized treatment groups. Future research should explore factors affecting convergence postconcussion and include randomized, controlled studies to determine if performing vision therapy improves visual measures and promotes recovery.
Kailin C. Parker, Rachel R. Shelton, and Rebecca M. Lopez
Clinical Scenario: In the last few years, there have been several studies examining alternative cooling strategies in the treatment of exertional heat stroke (EHS). Morbidity and mortality with EHS are associated with how long the patient’s core body temperature remains above the critical threshold of 40.5°C. Although cold-water immersion (CWI) is the gold standard of treatment when cooling a patient with EHS, more recent alternative cooling techniques have been examined for use in settings where CWI may not be feasible (ie, remote locations). Clinical Question: Do alternative cooling methods have effective core body temperature cooling rates for hyperthermia compared with previously established CWI cooling rates? Summary of Key Findings: The authors searched for studies using alternative cooling methods to cool hyperthermic individuals. To be included, the studies needed a PEDro score ≥6 and a level of evidence ≥2. They found 9 studies related to our focused clinical question; of these, 5 studies met the inclusion criteria. The cooling rates for hand cooling, cold-water shower, and ice-sheet cooling were 0.03°C/min, 0.08°C/min, and 0.06°C/min, respectively, whereas the tarp-assisted cooling with oscillation (TACO) method was the only method that had an acceptable cooling rate (range 0.14–0.17°C/min). Clinical Bottom Line: When treating EHS, if CWI is not available, the tarp-assisted cooling method may be a reasonable alternative. Clinicians should not use cold shower, hand cooling, or ice-sheet cooling if better cooling methods are available. Clinicians should always use CWI when available. Strength of Recommendation: Five level 2 studies with PEDro scores ≥6 suggest the TACO method is the only alternative cooling method that decreases core body temperature at a similar, though slower, rate of CWI. Hand cooling, cold showering, and ice-sheet cooling do not decrease core body temperature at an appropriate rate and should not be used in EHS situations if a modality with a better cooling rate is available.