Context: Acute lateral ankle sprain (LAS) is a common injury in athletes and is often associated with decreased athletic performance and, if treated poorly, can result in chronic ankle issues, such as instability. Physical performance demands, such as cutting, hopping, and landing, involved with certain sport participation suggests that the rehabilitation needs of an athlete after LAS may differ from those of the general population. Objective: To review the literature to determine the most effective rehabilitation interventions reported for athletes returning to sport after acute LAS. Evidence Acquisition: Data Sources: Databases PubMed, Embase, CINAHL, SPORTDiscus, and PEDro were searched to July 2020. Study Selection: A scoping review protocol was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines and registered (https://osf.io/bgek3/). Study selection included published articles on rehabilitation for ankle sprain in an athletic population. Data Extraction: Parameters included athlete and sport type, age, sex, intervention investigated, outcome measures, measurement tool, and follow-up period. Data Synthesis: A qualitative synthesis for all articles was undertaken, and a quantitative subanalysis of randomized controlled trials and critical methodological appraisal was also conducted. Evidence Synthesis: A total of 37 articles were included in this review consisting of 5 systematic and 20 narrative reviews, 7 randomized controlled trials, a single-case series, case report, position statement, critically appraised topic, and descriptive study. Randomized controlled trial interventions included early dynamic training, electrotherapy, and hydrotherapy. Conclusions: Early dynamic training after acute LAS in athletes results in a shorter time to return to sport, increased functional performance, and decreased self-reported reinjury. The results of this scoping review support an early functional and dynamic rehabilitation approach when compared to passive interventions for athletes returning to sport after LAS. Despite existing research on rehabilitation of LAS in the general population, a lack of evidence exists related to athletes seeking to return to sport.
Eugene Tee, Jack Melbourne, Larissa Sattler, and Wayne Hing
Stephanie Wise and Jordan Bettleyon
Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.
Jordyn Vienneau, Sandro Nigg, and Benno M. Nigg
This study compared electromyography of five leg muscles during a single walking task (WALK) to a dual task (walking + cognitive task; COG) in 40 individuals (20 M and 20 F) using a wavelet analysis technique. It was hypothesized that muscle activation during the dual task would differ significantly from the walking task with respect to both timing (H1) and frequency (H2). The mean overall intensity for the COG trials was 4.1% lower for the tibialis anterior and 5.5% higher for the gastrocnemius medialis than in the WALK trials. The changes between the WALK and COG trials were short 50 ms bursts that occurred within 100 ms of heel strike in the tibialis anterior, and longer activation periods during the stance phase in the gastrocnemius medialis. No changes in overall intensity were observed in the peroneus longus, gastrocnemius lateralis, or soleus. Furthermore, no clear frequency bands within the signal could further characterize the overall changes in muscle activity during the COG task. This advances our understanding of how the division of attentional resources affects muscle activity in a healthy population of adults.
Graig M. Chow, Lindsay M. Garinger, Jaison Freeman, Savanna K. Ward, and Matthew D. Bird
The aim of this study was to investigate expert practitioners’ approaches to conducting a first sport psychology session with individual clients as there is sparse empirical literature on this topic. Nine expert Certified Mental Performance Consultants completed a semistructured interview where they discussed experiences conducting a first meeting with an athlete. Primary objectives included establishing the relationship, setting guidelines and expectations, understanding the client’s background, identifying presenting concerns, and formulating the treatment plan and building skills. Building rapport was an aspect used to establish the relationship while discussing confidentiality was utilized to set guidelines. Important strategies employed to increase the perceived benefits to services included conveying the consulting approach and philosophy. Lessons learned centered around doing too much and not appreciating individual differences of clients. Findings show expert consultants aim to achieve similar broad objectives in the first session and provide a basis for best practices in this area.
Ju-Yul Yoon, Seung-Rok Kang, Hye-Seong Kim, Yu Hui Won, Sung-Hee Park, Jeong-Hwan Seo, Myoung-Hwan Ko, and Gi-Wook Kim
Context: Whole-body vibration (WBV) training improves muscle strength and balance. Few studies have focused on the effects of WBV frequencies below 30 Hz. We aimed to investigate the effect of low-frequency WBV training on muscle activity, fatigue recovery, and oxygen consumption (VO2). Design: Prospective single-group, repeated-measures study. Methods: In this controlled laboratory setting study, 20 healthy adults (age 23.26 [1.66] y) performed half squats at 0, 4, 6, 8, 12, 16, 20, 24, and 30-Hz WBV. Muscle activity was evaluated using the root mean square and peak electromyography amplitude of 6 muscles (iliocostalis, rectus abdominis, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius) obtained via surface electromyography. VO2 was measured during the squats using a gas analyzer, and fatigue recovery was evaluated using measurements of lactate after the squats and after a recovery period. Statistical significance was set at P < .05, and analysis of variance was conducted to determine differences in muscle activity, fatigue, recovery, and VO2, with post hoc analyses as appropriate. Results: Of the 6 muscles measured, the muscle activity of the gastrocnemius alone significantly increased from 0 Hz at 4, 8, 12, 16, 24, and 30 Hz based on the root mean square values and at 4, 8, 12, and 30 Hz based on the peak electromyography amplitude values. There were no significant differences in the other muscles. There were no significant differences in VO2 or in lactate levels. Conclusions: Low-frequency WBV during squat exercises significantly increased the activity of the gastrocnemius medialis only at specific frequencies in healthy young adults. Low-frequency WBV is safe and has the potential to increase muscle activity.
Ashley N. Marshall and Jennifer S. Howard
Shinji Yamaguchi, Yujiro Kawata, Yuka Murofushi, Nobuto Shibata, and Tsuneyoshi Ota
This study examined the stress coping strategies of athletes with high psychological vulnerability. The participants were 487 university athletes (mean age = 19.8 years, SD = 0.88, 153 women). Data were collected using the Vulnerability Scale for University Athletes and General Coping Questionnaire and analyzed by conducting a multivariate analysis of variance. The results showed significant relationships between vulnerability and coping strategies (r = .11−.39). Vulnerability was most strongly related to the emotional support seeking aspect of emotion-oriented coping (r = .39). There was no significant difference in cognitive reinterpretation (r = .07). Vulnerability had a stronger relationship with emotion-oriented than problem-oriented coping, and high (vs. low) vulnerability athletes had significantly higher emotion-oriented-coping scores. These results suggest that vulnerable athletes need to be provided with appropriate emotional support to cope with stressful situations, as they rely heavily on a stress management strategy focusing on emotion regulation.
Tatiana Tapajcikova, Dávid Líška, Ladislav Batalik, Clea P. Tucker, and Alena Kobesova
High-quality sensory perception and body scheme (somatognosis) are important aspects for sport performance. This study compares stereognosis, body scheme, and kinesthesia in a group of 36 competitive karate athletes against a control group of 32 general population participants. The stereognosis Petrie test, two body scheme tests, and three kinesthesia tests served as outcome measurement tools. No significant difference was found in the stereognosis Petrie test, for the dominant (p = .389) or the nondominant (p = .791) hand, nor in the kinesthesia test (dominant, p = .661 and nondominant, p = .051). Karate athletes performed significantly better in the body scheme tests, that is, fist width estimation (p = .024) and shoulder width estimation (p = .019), as well as in karate-specific kinesthesia tests, that is, single punch (p = .010) and triple punch (p = .001). This study confirms competitive karate athletes have significantly better somatognosis, and better accuracy when performing quick dynamic movements compared with the general population.