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The Efficiency of Respiratory Exercises in Rehabilitation of Low Back Pain: A Systematic Review and Meta-Analysis

Haiting Zhai, Liqing Zhang, JiXiang Xia, and Cheng Li

Background: Low back pain (LBP) is a common musculoskeletal disorder, and respiratory exercise is considered a nonsurgical management method. Therefore, this systematic review and meta-analysis aims to estimate the results of randomized controlled trials on the effect of respiratory training in reducing LBP and its dose relationship. Methods: The present study was conducted from January 2020 to January 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (2020). Relevant studies were searched in multiple databases including PubMed, Web of Science, the Cochrane Library, EBSCO, Scopus, ScienceDirect, Wan Fang and China Knowledge Network,, and Google Scholar, using a combination of MeSH/Emtree terms and free-text words. The heterogeneity of the studies was assessed using the I 2 statistic. Results: A total of 14 publications were included in the meta-analysis, with a total sample size of 698 individuals, aged 60–80 years. Respiratory exercise was effective in relieving LBP (standardized mean difference = −0.87, P < .00001) and improving physical disability (standardized mean difference = −0.79, P < .00001). The type of breathing and the total duration of breathing exercises were found to be the source of heterogeneity in this study by subgroup analysis. Subgroup analysis revealed that the most significant effect sizes of breathing resistance exercise to reduce LBP and the most significant effect sizes of breathing relaxation techniques to alleviate physical disability were performed 3 to 5 times per week and period >4 weeks. Respiratory exercise reducing LBP and improving functional disability was most effective when the total duration of the intervention was >500 minutes. Funnel plots showed that the results of the 2 overall studies were reliable without publication bias. Conclusions: Respiratory exercise can effectively reduce LBP and improve physical disability. Therefore, these exercises can be regarded as a part of a LBP management plan. We recommend an exercise program with 30 to 50 minutes, 3 to 5 times per week, and >4 weeks of breathing resistance exercise program as the most effective for treating LBP.

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In Remembrance: The Life and Legacy of Michael T. Turvey (1942–2023)

Michael A. Riley and Dagmar Sternad

Michael T. Turvey passed away on August 12, 2023 at the age of 81. This obituary aims to honor his life and career by highlighting some key events in his personal and professional life, noting some of his many remarkable accomplishments, and emphasizing his exceptional mentorship, friendship, and generosity.

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Relationship Between Knee Frontal Plane Projection Angle and Lower Limb Muscle Activity in Female Athletes

Luis Llurda-Almuzara, Max Canet-Vintró, Carlos López-de-Celis, Albert Perez-Bellmunt, Noé Labata-Lezaun, Ramón Aiguadé-Aiguadé, and Jacobo Rodriguez-Sanz

Context: Anterior cruciate ligament injuries are directly related to the control of dynamic knee valgus in the landing of a jump, and this is mainly due to the correct activation and neuromuscular function of the lower-extremity muscles. The aim of the study is to assess the relationship between lower limb muscle activity during a single-legged drop jump and knee frontal plane projection angle (FPPA). Design: A correlation study. Methods: Thirty healthy collegiate female athletes were included in the study. Main outcomes measures were peak knee FPPA and muscle activity (% of maximal voluntary isometric contraction). Peak knee FPPA during a single-legged drop jump test was identified using a 2-dimensional motion analysis system. Muscle activity was assessed using a surface electromyograph for gluteus maximus, gluteus medius, biceps femoris, semitendinosus, vastus medialis quadriceps, vastus lateralis quadriceps, medial gastrocnemius, and lateral gastrocnemius. All variables were assessed for both dominant and nondominant limbs. A correlation analysis between peak knee FPPA and muscle activity was performed. Statistical significance was set at P <.05. Results: A mean peak knee FPPA of 14.52° and 13.38° was identified for dominant and nondominant limb single-legged drop jump test, respectively. Muscle activity (% of maximal voluntary isometric contraction) for muscles assessed ranged from 43.97% to 195.71% during the single-legged drop jump test. The correlation analysis found no significant correlation between any of the muscles assessed and peak knee FPPA during the single-legged drop jump test (Pearson coefficient between −.3 and .1). Conclusions: There is no association between muscle activity from the lower limb muscles and the knee FPPA during a single-legged drop jump in female athletes. Thus, different muscle properties should be assessed in order to understand such an important movement as the knee FPPA during a jump.

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Preventing Suicide and Promoting Mental Health Among Student-Athletes From Diverse Backgrounds

Karrie L. Hamstra-Wright, John E. Coumbe-Lilley, and Eduardo E. Bustamante

Suicide and contributing mental health conditions in athletes are shared concerns within health care and society at large. This commentary focuses on suicide risk among athletes and the role of sports medicine professionals in preventing suicide and promoting mental health. In this commentary, we draw on the scientific literature and our clinical experiences to pose and answer these questions: Does suicide risk among athletes vary by sociodemographic factors (eg, sex, gender, race/ethnicity, family income, sexual orientation) or if injured? Do sociodemographic differences influence access to and benefits from services among athletes? How do I know my athletes are at risk for suicide? What do I do if one of my athletes shares with me that they have considered suicide? Within our commentary, we review the current literature and clinical practices regarding these questions and close with actionable suggestions and recommendations for future directions.

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Preparing the Athletic Trainer for Interprofessional Collaborative Practice: A Report From the Association for Athletic Training Education-Research Network

Sarah A. Manspeaker, Justin P. Young, Nicole A. Wilkins, Chad Clements, Dorice A. Hankemeier, Richelle M. Williams, Stacy E. Walker, and Lindsey E. Eberman

Contemporary health care emphasizes interprofessional collaborative practice (IPCP), described as when providers from two or more professions work together to achieve the highest-quality patient care. Historically, athletic trainers have naturally collaborated with physicians, in part due to our defined scope of practice, but more importantly as a benefit to achieving positive patient outcomes. Athletic trainers also collaborate with nurses, physical therapists, physician assistants, and other health care professionals when providing care to physically active patients and populations. Due to the oftentimes continuous contact with patients while engaging these other health care professionals, athletic trainers are well suited to expand their interprofessional collaborations to other disciplines and serve as key stakeholders in the IPCP team. To assist in this expansion of IPCP, there are several professional organizations and a substantial body of literature focusing on effective engagement in IPCP that can serve as resources for athletic training. This commentary will address the background of IPCP and the relevance of the athletic trainer within the interprofessional team, as well as identify resources for additional information.

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Automated Versus Traditional Scoring Agreeability During the Balance Error Scoring System

Amelia S. Bruce Leicht, James T. Patrie, Mark A. Sutherlin, Madeline Smart, and Joe M. Hart

Context: The Balance Error Scoring System (BESS) is a commonly used clinical tool to evaluate postural control that is traditionally performed through visual assessment and subjective evaluation of balance errors. The purpose of this study was to evaluate an automated computer-based scoring system using an instrumented pressure mat compared to the traditional human-based manual assessment. Design: A descriptive cross-sectional study design was used to evaluate the performance of the automated versus human BESS scoring methodology in healthy individuals. Methods: Fifty-one healthy active participants performed BESS trials following standard BESS procedures on an instrumented pressure mat (MobileMat, Tekscan Inc). Trained evaluators manually scored balance errors from frontal and sagittal plane video recordings for comparison to errors scored using center of force measurements and an automated scoring software (SportsAT, version 2.0.2, Tekscan Inc). A linear mixed model was used to determine measurement discrepancies across the 2 methods. Bland–Altman analyses were conducted to determine limit of agreement for the automated and manual scoring methods. Results: Significant differences between the automated and manual errors scored were observed across all conditions (P < .05), excluding bilateral firm stance. The greatest discrepancy between scoring methods was during the tandem foam stance, while the smallest discrepancy was during the tandem firm stance. Conclusion: The 2 methods of BESS scoring are different with wide limits of agreement. The benefits and risks of each approach to error scoring should be considered when selecting the most appropriate metric for clinical use or research studies.

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Erratum. Influence of Graft Type and Meniscal Involvement on Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction

Journal of Sport Rehabilitation

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Examining the Feasibility of a Mindfulness Flow Program for the Hong Kong Archers

Ka K. Lo, Mimi M.Y. Tse, Joanne W.Y. Chung, Queenie P.S. Law, and Fenghua Sun

Mindfulness-based interventions have gained popularity among elite athletes, but their effectiveness in enhancing archery performance has been inconsistent. This study examined the feasibility of a 12-week mindfulness flow program (MFP) specifically designed for the archers and assessed the effect of the MFP on shooting performance. Twelve members of the Hong Kong Archery Team voluntarily participated in the present study. Their shooting performance, anxiety, mindfulness, and flow state were assessed before and after the MFP intervention. The results showed that the MFP was highly feasible, with 100% attendance. The athletes highly enjoyed the MFP sessions (mean rating: 7.9/10). Improved shooting performance, increased mindfulness, and flow state levels, and reduced anxiety were also observed after the intervention. These findings suggest a positive reception from and potential benefits for athletes. However, it is suggested to conduct additional research using randomized controlled trials to explore the program’s effects and applicability in enhancing sports performance.

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A Quasi-Randomized Clinical Trial to Compare the Effects of Suspension Versus Instability Training on Balance

José-María Blasco, Catalina Tolsada-Velasco, Irene Borja-de-Fuentes, Elena Costa-Moreno, Carmen García-Gomáriz, and David Hernández-Guillén

Context: Suspension training devices are becoming increasingly popular. Most studies analyzed the effectiveness according to diverse measures in patients with or without conditions at any age. The characteristics of suspension training are very specific and can increase instability and; therefore, enhance balance. The goal was to determine the effects of suspension training on balance by comparing it with instability training. Design: Two-arm, randomized trial. Methods: 44 young adults, aged 22.4 years old, with no musculoskeletal condition, took part. There were 2 interventions, suspension and instability training, designed with 12 sessions in 4 weeks. The primary outcome was the Y-Balance test. Other balance outcomes were the Emery and jumping sideways tests, and platform measures while standing. Results: Suspension and instability training were effective in enhancing balance in terms of the primary outcome, the Y-Balance test, with no between-group differences. Instability training enhanced the Emery test over suspension training (P = .018), but the latter was more effective in the jumping sideways test (P = .003). Neither of the training improved static balance measures. Conclusions: Training with suspension devices is effective in enhancing dynamic balance, with similar improvements to instability training. Importantly, the magnitude of change and the frequency of responders to intervention in terms of motor coordination and keeping balance in unstable conditions appear to be sensitive to the type of training.

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Physical Activity and Engagement Coping: A Key for Stress-Recovery in Mexican University Students

Erick-Yael Fernández-Barradas, María-Luisa Marván-Garduño, Tamara Cibrián-Llanderal, Felipe Reynoso-Sánchez, and Socorro Herrera-Meza

Physical activity and coping styles are factors that contribute to health status and to the reduction of stress. The aim of this research was to analyze the influence of physical activity and coping styles on recovery-stress state among Regular Physical Activity University Students (n = 67) and High-Performance University Athletes (n = 67) from a Mexican university. The results show statistically significant differences in the capacity of recovery from stress in High-Performance University Athletes. Additionally, two positive correlations emerged: one of engagement coping and recovery, and one of disengagement coping and stress. The interaction between engagement coping and physical activity predicted general well-being. In females, the engagement coping style predicts recovery from stress. We concluded that physical activity in combination with an engagement coping style contributes to the development of health in university students.