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Fırat Tan, Hande Guney-Deniz, Gulcan Harput, Burak Ulusoy, Gürhan Dönmez, John Nyland, and Mahmut N. Doral

Context: The study purpose was to compare the ankle muscle activation and dynamic ankle joint stability of subjects who underwent endoscopy-assisted Achilles tendon repair (ATR; at ≥ 2 y postsurgery) with age, gender, and activity level-matched healthy control group subjects. Design: Prospective, cross-sectional study. All functional tests were performed on the involved ankle of the ATR group, and at the matched side of healthy age, gender, and activity-level control group subjects. Methods: Fifteen men in each group were evaluated for medial and lateral gastrocnemius, soleus, tibialis anterior, and peroneus longus muscle activation during modified star excursion balance test and heel-rise test performance. The weight-bearing lunge test (ankle dorsiflexion) and heel-rise test distance (ankle plantar flexion) also determined weight-bearing, active ankle mobility magnitudes. The Achilles Tendon Total Rupture Score and Foot and Ankle Outcome Score provided patient-reported outcome perceptions specific to Achilles tendon rupture and comprehensive foot and ankle symptoms and function, respectively. Results: Medial (P = .005) and lateral (P = .012) gastrocnemius displayed greater activation amplitudes in the ATR group during the star excursion balance test, and peroneus longus displayed greater activation amplitudes during the heel-rise test (P = .006). The star excursion balance test reach distance was comparable between groups. Active weight-bearing ankle plantar flexion (heel-rise test) and dorsiflexion (weight-bearing lunge test) mobility magnitudes were lower in the ATR group. Conclusions: Subjects who underwent endoscopy-assisted percutaneous ATR had reduced active weight-bearing ankle dorsiflexion and plantar flexion mobility magnitudes and greater gastrocnemius and peroneus longus neuromuscular activation when performing the same tasks as healthy control group subjects. As surgical approaches evolve to less invasive, soft tissue preserving methods with less tissue morbidity and faster healing, rehabilitation approaches may likewise need to evolve. Level of Evidence: Level III.

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Rodrigo Rodrigues Gomes Costa, Matt Laurent, Frederico Ribeiro Neto, Luis Felipe Castelli Correa de Campos, and Ciro Winckler

Context: One of the primary training variables, although often overlooked, is recovery level achieved before starting subsequent training sessions. To find a more practical measurement that is consonant with the daily training routine, the Perceived Recovery Status (PRS) scale is proposed. In this perspective, the present study aimed to translate and culturally adapt the PRS scale into Brazilian Portuguese. Design: This was a clinical measurement. Methods: The cross-cultural translation was performed according to guidelines. Linguistic validation consisted of 5 stages: forward translation, translation synthesis, back translation, analysis of inconsistencies, and cognitive debriefing. Results: During forward translation, different interpretations were obtained from the 2 translators (versions V1 and V2). Supported by an expert committee, a combined version (V3) was obtained from V1 and V2. During back translation, different interpretations were obtained from the 2 translators (versions V4 and V5). Discrepancies, applicability, and cultural equivalence were documented and analyzed by the expert committee participating in the cross-cultural translation procedure. During the cognitive debriefing, a group of 5 Brazilian people from the general population were asked to participate in a cognitive debriefing to assess the comprehensibility of the translated items. Conclusions: The PRS was translated and culturally adapted to Brazilian Portuguese (PRS-Brasil).

Open access

Mingke You, Lingcheng Wang, Ruipeng Huang, Kaibo Zhang, Yunhe Mao, Gang Chen, and Jian Li

Context: Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. Objective: To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). Evidence Acquisition: Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. Evidence Synthesis: Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = −4.66; 95% confidence interval, −8.6 to −0.73; P = .02; I 2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior–posterior view (mean difference = −7.08; 95% confidence interval, −10.92 to −3.24; P = .0003; I 2 = 0%) and lateral view (mean difference = −10.33; 95% confidence interval, −16.9 to −3.75; P = .002; I 2 = 17%). Conclusion: This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.

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Eleftherios Paraskevopoulos, George Koumantakis, and Maria Papandreou

Context: Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. Objective: To determine the effectiveness of NE in CR on pain, function, and ROM. Design: Systematic review and meta-analysis. Evidence Acquisition: An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. Evidence Synthesis: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was −1.33/10 (95% confidence interval [CI], −1.80 to −0.86; P < .01; I 2 = 0%), for function with the Neck Disability Index was −1.21/50 (95% CI, −1.67 to −0.75; P < .01; I 2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I 2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I 2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. Conclusions: Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.

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Jacqueline A. Augustine, Sarah Rothstein, Larissa True, and Kevin D. Dames

Context: A variety of gait retraining interventions are available to modify running mechanics associated with musculoskeletal injuries. These often require specialized equipment and/or personnel to prompt the runner toward specific strategies. Objective: To determine whether instructing female recreational runners to “run quietly” could decrease impact force characteristics. Design: Cohort. Setting: Research laboratory. Participants: Fifteen healthy female recreational runners (24 [7] y) volunteered. Interventions: Baseline testing occurred on day 1 (baseline), a posttraining assessment occurred on day 2 (training), and a final assessment occurred 1 week after training on day 3 (follow-up). A smartphone decibel measuring app was used to provide biofeedback on the decibel level of foot strike on day 2 (training). Main Outcomes: Peak vertical force, impact transient, peak and average vertical loading rate, ground contact time, and running economy were collected on each day and compared via repeated-measures analyses of variance. Results: Vertical ground reaction force was lower at follow-up (2.30 bodyweights [BW]) versus baseline (2.39 BW, P = .023) and training (2.34 BW, P = .047). Maximal loading rate decreased from baseline (69.70 BW·s−1) to training (62.24 BW·s−1, P = .021) and follow-up (60.35 BW·s−1, P = .031). There was no change in running economy. Conclusions: Our findings demonstrate that simple instructions to “run quietly” can yield immediate and sustained reductions in impact force profiles, which do not influence running economy.

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Karissa L. Johnson, Danielle L. Cormier, Kent C. Kowalski, and Amber D. Mosewich

Helping athletes cope effectively with injury is likely of great interest to many sport stakeholders. Mental toughness is one psychological factor positively associated with resilience and sport performance, though stubborn persistence through injury might not always be conducive to adaptive athlete outcomes. Self-compassion—a balanced, nonjudgmental approach in relating to oneself when experiencing suffering—might help circumvent these pitfalls and complement injury recovery. The purpose of this study was to explore the relationship between mental toughness and self-compassion in a sport injury context. This study consisted of 2 phases—phase I quantitatively assessed the relationships between mental toughness, self-compassion, and other psychological constructs, while phase II used qualitative interviews to corroborate and inform these findings. In phase I, competitive athletes who were injured at the time of data collection (n = 81) completed mental toughness, self-compassion, coping resources, self-esteem, and self-criticism questionnaires. Self-compassion was positively correlated with mental toughness (r = .48, P < .01), coping resources (r = .54, P < .05), and self-esteem (r = .60, P < .01). Self-compassion and self-criticism were negatively correlated with each other (r = –.52, P < .01). Results from hierarchical multiple regression analyses revealed that self-compassion was a significant predictor of mental toughness (ΔR 2 = .07, P < .01), coping resources (ΔR 2 = .10, P < .01), and self-criticism (ΔR 2 = .06, P < .01), beyond the effects of self-esteem. Four injured athletes who scored above the median on mental toughness and self-compassion measures were interviewed in phase II. Thematic analysis generated 2 themes: (1) self-compassion grants access to wise mental toughness and (2) mental toughness helps activate self-compassionate actions during injury. These findings are consistent with recent research and suggest that both mental toughness and self-compassion can work together to help athletes cope with sport injury.

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Christopher D. Riehm, Scott Bonnette, Michael A. Riley, Jed A. Diekfuss, Christopher A. DiCesare, Andrew Schille, Adam W. Kiefer, Neeru A. Jayanthi, Stephanie Kliethermes, Rhodri S. Lloyd, Mathew W. Pombo, and Gregory D. Myer

Background: Young athletes who specialize early in a single sport may subsequently be at increased risk of injury. While heightened injury risk has been theorized to be related to volume or length of exposure to a single sport, the development of unhealthy, homogenous movement patterns, and rigid neuromuscular control strategies may also be indicted. Unfortunately, traditional laboratory assessments have limited capability to expose such deficits due to the simplistic and constrained nature of laboratory measurement techniques and analyses. Methods: To overcome limitations of prior studies, the authors proposed a soccer-specific virtual reality header assessment to characterize the generalized movement regularity of 44 young female athletes relative to their degree of sport specialization (high vs low). Participants also completed a traditional drop vertical jump assessment. Results: During the virtual reality header assessment, significant differences in center of gravity sample entropy (a measure of movement regularity) were present between specialized (center of gravity sample entropy: mean = 0.08, SD = 0.02) and nonspecialized center of gravity sample entropy: mean = 0.10, SD = 0.03) groups. Specifically, specialized athletes exhibited more regular movement patterns during the soccer header than the nonspecialized athletes. However, no significant between-group differences were observed when comparing participants’ center of gravity time series data from the drop vertical jump assessment. Conclusions: This pattern of altered movement strategy indicates that realistic, sport-specific virtual reality assessments may be uniquely beneficial in exposing overly rigid movement patterns of individuals who engage in repeated sport specialized practice.

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Francesca M. Genoese, Matthew S. Harkey, and Shelby E. Baez

Individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms commonly exhibit psychological impairments, such as pain catastrophizing. Pain catastrophizing is a negative cognitive–affective response to anticipated or actual pain and has been linked to greater pain intensity and decreased function in this population. However, an examination of the neuromatrix theory of pain and the transactional theory of stress and coping may help to explain the development and consequences of pain catastrophizing in individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms. Exploration of these theoretical models will help clinicians better understand the impact of pain catastrophizing on post-injury outcomes, as well as help to identify intervention strategies to address maladaptive psychological responses and improve outcomes for individuals with anterior cruciate ligament reconstruction and early knee osteoarthritis symptoms.

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Eleftherios Paraskevopoulos, Georgios Gioftsos, Georgios Georgoudis, and Maria Papandreou

Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.

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Heidi Stanish, Samantha M. Ross, Byron Lai, Justin A. Haegele, Joonkoo Yun, and Sean Healy

The U.S. Report Card on Physical Activity for Children and Youth has tracked 10 physical activity (PA) indicators common to the Active Healthy Kids Global Matrix since 2014. This article expands on the U.S. report cards by presenting PA indicator assessments among children and adolescents with disabilities. Grades for indicators were assigned based on a search of peer-reviewed articles presenting nationally representative data. The Global Matrix 3.0 benchmarks and grading framework guided the process. Grades for overall PA, sedentary behaviors, organized sports, and school were F, D+, D+, and D, respectively. Insufficient evidence existed to assign grades to the remaining six indicators. There is a need in the United States for targeted PA promotion strategies that are specific to children and adolescents with disabilities. Without a commitment to this effort across sectors and settings, the low grades identified in this para report card are expected to remain.