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Bruno Augusto Lima Coelho, Helena Larissa das Neves Rodrigues, Gabriel Peixoto Leão Almeida, and Sílvia Maria Amado João

Context: Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. Objectives: To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. Design: Randomized controlled trial with 3 arms. Setting: Biomechanics laboratory. Participants: A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). Intervention(s): The participants received a single session of ankle mobilization with movement technique. Main Outcome Measures: Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). Results: There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. Conclusion: In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.

Open access

John Kuzmeski, Gillian Weir, Travis Johnson, Matthew Salzano, and Joseph Hamill

This study investigated the differences between 5 commonly used methods to calculate leg stiffness over a range of running velocities. Thirteen male, habitually rearfoot, recreational runners ran on a force instrumented treadmill for a 5-minute running session. Each session consisted of 30-second intervals at 6 progressively faster speeds from 2.5 m·s−1 through 5.0 m·s−1 with each interval speed increasing by 0.5 m·s−1. Two-way within-factors repeated-measures analyses of variance were used to evaluate leg stiffness and length. A one-way repeated-measures analysis of variance was used to evaluate the slope of each trend line of each model across speeds. Pearson correlations were used to compare the relationship between the different computational methods. The results indicated that the direct stiffness methods increased with speed whereas the indirect stiffness methods did not. The direct methods were strongly correlated with each other as were the indirect methods. However, there were no strong correlations between the direct and indirect methods. These differences can be mostly attributed to how each individual stiffness method calculated leg length. It is important for researchers to understand these differences when conducting future studies and comparing past studies.

Open access

Michal Vágner, Zdeněk Bílek, Karel Sýkora, Vladimír Michalička, Lubomír Přívětivý, Miloš Fiala, Adam Maszczyk, and Petr Stastny

The aim of this study was to find the effect of holographic sight (HS) on short-distance shooting accuracy and precision during static and high-intensity dynamic actions. Twenty policemen (31 ± 2.2 years, 85.6 ± 6.1 kg, and 181.9 ± 4.4 cm) performed five shots in the 10-s limit under the static condition for 20 m and dynamic condition 15–5 m, and after 4 × 10 m sprint action, both with fixed sight (FS) and HS. The analysis of variance post hoc test revealed that HSstatic had higher shouting accuracy than FSstatic, FSdynamic, and HSdynamic (p = .03, p = .0001, and p = .0001, respectively) and FSdynamic had lower precision than FSstatic, HSstatic, and HSdynamic (p = .0003, p = .0001, and p = .01, respectively) in vertical sway. The HS for rifles has improved the accuracy of static shooting and vertical sway precision of dynamic shooting.

Open access

Lisa Chaba, Stéphanie Scoffier-Mériaux, Fabienne d’Arripe-Longueville, and Vanessa Lentillon-Kaestner

This article focuses on two popular sports that can put male athletes at risk of developing an eating disorder: bodybuilding and running. Bodybuilders concentrate on gaining muscle mass and runners on leaning body mass. Based on the trans-contextual model of motivation, this study aimed to better understand the psychological mechanisms underlying eating disorders in these athletes. In all, 272 male bodybuilders and 217 male runners completed measures of sport motivation, theory of planned behavior variables (i.e., attitude, subjective norm, perceived behavioral control, and intention to gain muscle mass/lean body mass), and eating disorders (dieting, control, and bulimia behaviors). The results revealed satisfactory fit indices for both samples. Autonomous and controlled motivations for sport were positively directly and indirectly related to eating disorders in these athletes. This motivational mechanism needs more in-depth investigation, and motivational profiles might help distinguish athletes with and without eating disorders.

Open access

Kyndell R. Crowell, Ryan D. Nokes, and Nicole L. Cosby

Clinical Scenario: Dynamic knee valgus (DKV) is a mechanical alteration in the knee that leads to increased risk of injury. Weakness of hip musculature in hip abduction (HABD), extension (HEXT), and external rotation (HER) may contribute to increased DKV in single-leg landing tasks. Focused Clinical Question: Is decreased hip strength associated with an increase in DKV during a single-leg landing task in collegiate female athletes? Summary of Key Findings: Three studies were included: One randomized control trial (RCT), one cohort study, and one case-control. All three studies found that decreases in HABD and HER strength contributed to increased DKV during single-leg landing tasks. One study also found that the hip extensors contribute to controlling hip adduction, a common factor in many mechanisms of injuries. These three studies recommended strengthening HABD, HEXT, and HER to decrease DKV and reduce the risk of injury at the knee. Clinical Bottom Line: Weak HABD, HEXT, and HER contribute to increased DKV in college female athletes, but strengthening HABD, HEXT, and HER can lead to decreases in DKV and, overall, reduce the risk of injury at the knee. Strength of Recommendation: These articles were graded with a level of evidence of III or higher, giving a grade of B strength of recommendation that weak HABD, HEXT, and HER are associated with increased DKV in collegiate female athletes.

Open access

Ling Zhang, Shao-bai Wang, Shuai Fan, Jiling Ye, and Bin Cai

Context: Performance in strength and assessment of patellar tracking is important for patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. Objective: The study was to examine the difference of patellofemoral kinematics between the affected and the contralateral limb and to evaluate the relationship between knee extensor strength and patellofemoral kinematics in patients with arthrofibrosis after ACL reconstruction. Design: Cohort study (diagnosis); level of evidence, 3. Setting: Laboratory. Patients: A prospective cohort of 20 patients with arthrofibrosis after ACL reconstruction was recruited. Interventions: A total of 20 patients who underwent arthroscopic reconstruction of the double-bundle ACL with a hamstring tendon autograft received standardized patellofemoral kinematics testing and knee extensor strength testing within 6 months after primary ACL reconstruction. Computed tomography and dual fluoroscopic imaging were used to evaluate in vivo patellofemoral kinematics of affected and contralateral knees during a lunge task. Knee extensor mechanism strength was measured using a handheld dynamometer. Main Outcome Measures: A limb symmetry index of knee strength and patellar mobility was calculated and satisfactory performance defined as ≥90%. Results: There was a statistically significant decrease in the range of patellar inferior shift (P = .020; d = 0.81), flexion (P = .026; d = 0.95), lateral tilt (P = .001; d = 1.04), and lateral rotation (P < .001; d = 0.89) in the affected knee compared with the contralateral knee from 15° to 75° of knee flexion. There was a strong positive linear correlation between knee extensor strength and patellar inferior shift (r = .747; P = .008). A knee extensor strength limb symmetry index <90% was 89% sensitive and 9% specific for limited patellar inferior shift. Conclusions: Patients with arthrofibrosis after ACL reconstruction presented decreased patellar mobility in the arthrofibrotic knee compared with the contralateral knee. The strong correlation between knee extensor strength and patellar inferior shift of the arthrofibrotic knee demonstrates the importance of knee extensor strength in the diagnosis and treatment of patients with knee arthrofibrosis. The knee extensor mechanism strength has high sensitivity but low specificity in identifying a decrease in patellar inferior shift in patients with arthrofibrosis after ACL reconstruction.

Open access

Jessica Murphy, Karen A. Patte, Philip Sullivan, and Scott T. Leatherdale

The mental health benefits of physical activity may relate more to the context of the behavior, rather than the behavior of being active itself. The association between varsity sport (VS) participation, depression, and anxiety symptoms was explored using data from 70,449 high school students from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior study. The model adjusted for potential covariates; interactions by sex and participation in outside of school sport (OSS) were explored. Overall, 70% and 24% of respondents met or exceeded cutoff values for depression and anxiety, respectively. Students participating in VS had lower symptoms of anxiety and depression compared with nonparticipants. Results were consistent regardless of OSS participation; associations were strongest among students who participated in both VS and OSS and males. Participation in VS may prove beneficial for the prevention and/or management of depression or anxiety symptoms, particularly among males. An additive beneficial effect of OSS on depression and anxiety scores may exist.

Open access

Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III

While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.

Open access

Jamon Couch, Marc Sayers, and Tania Pizzari

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across HDD and ForceFrame dynamometry (intraclass correlation coefficients [3, 1]  = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.

Open access

Nickolai J.P. Martonick, Ashley J. Reeves, James A. Whitlock, Taylor C. Stevenson, Scott W. Cheatham, Craig P. McGowan, and Russell T. Baker

Context: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. Objective: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. Design: Experimental. Setting: University research laboratory. Participants: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). Intervention: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. Main Outcome Measures: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. Results: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. Conclusions: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.