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Leveraging the Momentum

Luke Donovan

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Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis

Matheus Hissa Lourenço Ferreira, Guilherme Augusto Santos Araujo, and Blanca De-La-Cruz-Torrez

Context: Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing. Objective(s): The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis. Evidence Acquisition: The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT. Evidence Synthesis: Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = −0.97; 95% CI, −1.26 to −0.68; I 2  = 58%; low certainty of evidence) and in the short-term (SMD = −0.83, 95% CI, −1.29 to −0.38; I 2  = 65%; low certainty of evidence), midterm (SMD = −1.28; 95% CI, −1.65 to −0.91; I 2  = 0%; moderate certainty of evidence), and long-term (SMD = −0.94; 95% CI, −1.62 to −0.26; I 2  = 71%; low certainty of evidence) subgroups. Conclusion(s): The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.

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Feasibility and Preliminary Effectiveness of an Online Meditation Intervention in Young Adults With Concussion History

Christine E. Callahan, Kyla Z. Donnelly, Susan A. Gaylord, Keturah R. Faurot, J.D. DeFreese, Adam W. Kiefer, and Johna K. Register-Mihalik

Context: Mindfulness interventions (yoga, meditation) in traumatic brain injury populations show promising improvements in injury outcomes. However, most studies include all injury severities and use in-person, general programming lacking accessibility and specificity to the nuance of concussion. Therefore, this study investigated the feasibility and preliminary effectiveness of an online, concussion-focused meditation intervention among young adults with a concussion history. Design: Unblinded, single-arm, pilot intervention. Methods: Fifteen young adults aged 18 to 30 with a concussion history within the past 5 years completed 10 to 20 minutes per day of online, guided meditations for 6 weeks. Feasibility was assessed using the Feasibility of Intervention Measure. Concussion symptoms were measured using the Rivermead Post-Concussion Symptom Questionnaire, perceived stress the Perceived Stress Scale-10, and mindfulness the Five Facet Mindfulness Questionnaire. Descriptive statistics described the study sample and determined intervention adherence and feasibility. Paired sample t tests were used to examine preintervention/postintervention changes in concussion symptoms, perceived stress, and mindfulness, with descriptive statistics further detailing significant t tests. Results: Fifteen participants were enrolled, and 12 completed the intervention. The majority completed 5+ days per week of the meditations, and Feasibility of Intervention Measure (17.4 [1.8]) scores indicated high feasibility. Concussion symptom severity significantly decreased after completing the meditation intervention (11.3 [10.3]) compared with before the intervention (24.5 [17.2]; t[11] = 3.0, P = .01). The number of concussion symptoms reported as worse than before their concussion significantly decreased after completing the meditation intervention (2.7 [3.9]) compared with before the intervention (8.0 [5.7]; t[11] = 3.7, P = .004). Postintervention, 83.33% (n = 10) reported lower concussion symptom severity, and 75.00% (n = 9) reported less concussion symptoms as a mild, moderate, or severe problem (ie, worse than before injury). Conclusions: Findings suggest positive adherence and feasibility of the meditation intervention, with the majority reporting concussion symptom improvement postintervention. Future research is necessary to expand these pilot findings into a large trial investigating concussion-specific meditation programming.

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Erratum. Effect of Mindful Sports Performance Enhancement in College Athletes for Reducing Sports-Caused Anxiety and Improving Self-Awareness: A Critically Appraised Topic

International Journal of Athletic Therapy and Training

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Mindfulness and Psychological Inflexibility in Portuguese Adolescent Athletes: A Novel Framework for Understanding the Link Between Shame and Sports Anxiety

Sara Margarida Simões de Oliveira, Marina Isabel Vieira Antunes Cunha, António Fernando Boleto Rosado, Mariana Saraiva, and Cláudia Rute Carlos Ferreira

This study aimed to test a comprehensive model in adolescent athletes that explores the effect of shame on sports anxiety and whether psychological inflexibility and mindfulness influence this association. The sample study included 210 young Portuguese athletes from different competitive sports. The path analysis results confirmed the adequacy of the proposed model, which explained 49% of the variance in sports anxiety. Results demonstrated that athletes who experienced higher levels of shame tended to exhibit elevated levels of sports anxiety through lower levels of mindfulness and higher psychological inflexibility. The study offers new empirical data that may be relevant for clinical and sport psychology practitioners. These findings seem to underline the importance of addressing shame and, consequently, sports anxiety in adolescent athletes by developing greater psychological flexibility and, inherently, more mindfulness skills among adolescent athletes who are in a phase of their lives where sport can play a crucial role.

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Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study

Nicola Marotta, Alessandro de Sire, Isabella Bartalotta, Maria Sgro, Roberta Zito, Marco Invernizzi, Antonio Ammendolia, and Teresa Iona

Introduction: Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. Methods: Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. Results: We included a group of 18 male (aged 24–39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. Conclusions: FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.

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Erratum. The Relationship Between Childhood Trauma, Exercise Addiction, Emotion Regulation Difficulties, and Basic Psychological Needs in Türkiye

Journal of Clinical Sport Psychology

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Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players

Lukáš Slovák, David Zahradník, William M. Land, Javad Sarvestan, Joseph Hamill, and Reza Abdollahipour

The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.

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Treating Dystonia in a Soccer Player Through an Integrated Rehabilitative Approach: A Case Report

Valeria Giorgi, Giovanni Apostolo, and Laura Bertelè

Context: Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete’s ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined. Case Presentation: We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely. Management and Outcomes: An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer. Conclusions: This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations.

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Effect of Neurofeedback Training Along With Swimming Exercise on the Stress, Anxiety, Depression, Severity of Dependence, and Craving in Methamphetamine-Dependent Patients

Atefeh Fadaei, Mahmoud Najafi, Hossein Miladi-Gorji, Mohammad Ali Tajik-Mansoury, and Mohammad Afkar

This study investigated whether neurofeedback (NFB) training and swimming exercise (Swim) would reduce the stress, anxiety, depression, severity of dependence, and cravings in patients addicted to methamphetamines. Participants were allocated randomly to four groups: control group, NFB, Swim, and NFB/Swim. All groups completed the study questionnaire before and after treatment. The NFB, Swim, and NFB/Swim groups reported significantly less stress, cravings, and severity of dependence than the control group. The Swim and NFB/Swim groups had significantly lower depression scores than the control group. Also, the NFB/Swim group experienced less anxiety than the control group. However, the NFB/Swim group had lower levels of stress than the Swim group, and lower levels of anxiety and severity of dependence than the NFB group. These findings suggest that NFB training along with swimming exercise was effective in managing methamphetamine-related behavioral disturbances, which may help patients to manage their cravings.