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Open access

Theodore Kent Kessinger, Bridget Melton, Theresa Miyashita, and Greg Ryan

Clinical Scenario: Manipulation of exercise variables in resistance training (RT) is an important component in the development of muscular strength, power, and hypertrophy. Currently, most research centers on untrained or recreationally trained subjects. This critically appraised topic focuses on studies that center on the well-trained subject with regard to frequency of training. Clinical Question: In well-trained male subjects, is there an association between RT frequency and the development of muscular strength and hypertrophy? Summary of Key Findings: Four studies met the inclusion criteria and were included for analysis. All studies showed that lower-frequency training could elicit muscular strength and hypertrophy increases. One study suggested that a higher frequency compared with a lower frequency may provide a slight benefit to hypertrophic development. One study reported a greater level of delayed onset muscle soreness with lower frequency training. The 4 studies demonstrate support for the clinical question. Clinical Bottom Line: Current evidence suggests that lower-frequency RT produces equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT when volume is equated. The evidence is particularly convincing when lower-frequency RT is associated with a total-body training protocol in well-trained male subjects. Strength of Recommendation: There is moderate-to-strong evidence to suggest that lower-frequency RT, when volume is equated, will produce equal to greater improvements on muscular strength and hypertrophy in comparison to higher-frequency RT.

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Cameron Bolton, Sheri Hale, and Todd Telemeco

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.

Open access

Abbey Thomas and Jeffrey B. Driban

Open access

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.

Open access

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.

Open access

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.

Open access

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.

Open access

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.

Open access

Walter Herzog