Context: Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR. Design: Cross-sectional study. Methods: A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR. Results: Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent. Conclusion: Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.
Mandeep Kaur, Daniel Cury Ribeiro, Kate E. Webster, and Gisela Sole
Fei Tian, Yaqi Zhao, Jixin Li, Wenjin Wang, Danni Wu, Qiang Li, Liyun Guo, and Shaobai Wang
Context: Many methods used to evaluate knee proprioception have shortcomings that limit their use in clinical settings. Based on an inexpensive 3D camera, a new portable device was recently used to evaluate the joint position sense (JPS) of the knee joint. However, the test–retest reliability of the new method remains unclear. This study aimed to evaluate the test–retest reliability of the new device and a long-arm goniometer for assessing knee JPS, and to compare the variability of the 2 methods. Design: Prospective observational study of the test–retest reliability of knee JPS measurements. Methods: Twenty-one healthy adults were tested in 2 sessions with a 1-week interval. Three target knee flexion angles (30°, 45°, and 60°) were reproduced in each session. Target and reproduced angles were measured with both methods. Intraclass correlation coefficients, standard error of the measurement, and Bland–Altman plots were used to quantify test–retest reliability. Paired t tests were used to compare knee JPS (absolute error of the target-reproduced angle) between the methods. Results: The new device (good to excellent intraclass correlation coefficients .74–.80; standard error of the measurement 0.52°–0.61°) demonstrated better test–retest reliability than the goniometer (poor to fair intraclass correlation coefficients .23–.43; standard error of the measurement 0.89°–2.07°) and better test–retest agreement (respective mean differences for the 30°, 45°, and 60° knee angles: 0.11°, 0.13°, and 0.41° for the new system; 0.84°, 1.52°, and 1.18° for the goniometer). The measurements (absolute errors of the target-reproduced angles) with the goniometer were significantly greater than those with the new device (P < .05); the SDs of repeated measurements with the goniometer (1.50°–2.41°) were greater than with the new device (1.08°–1.38°). Conclusions: Given that the new device has good reliability and sufficient precision, it is the better alternative for evaluating knee JPS. Goniometers should be used with caution to assess knee JPS.
Warlindo Carneiro da Silva Neto, Alexandre Dias Lopes, and Ana Paula Ribeiro
Context: Running is a popular sport globally. Previous studies have used a gait retraining program to successfully lower impact loading, which has been associated with lower injury rates in recreational runners. However, there is an absence of studies on the effect of this training program on the plantar pressure distribution pattern during running. Objective: To investigate the short-term effect of a gait retraining strategy that uses visual biofeedback on the plantar pressure distribution pattern and foot posture in recreational runners. Design: Randomized controlled trial. Setting: Biomechanics laboratory. Participants: Twenty-four recreational runners were evaluated (n = 12 gait retraining group and n = 12 control group). Intervention: Those in the gait retraining group underwent a 2-week program (4 sessions/wk, 30 min/session, and 8 sessions). The participants in the control group were also invited to the laboratory (8 times in 2 wk), but no feedback on their running biomechanics was provided. Main Outcome Measures: The primary outcome measures were plantar pressure distribution and plantar arch index using a pressure platform. The secondary outcome measure was the foot posture index. Results: The gait retraining program with visual biofeedback was effective in reducing medial and lateral rearfoot plantar pressure after intervention and when compared with the control group. In the static condition, the pressure peak and maximum force on the forefoot and midfoot were reduced, and arch index was increased after intervention. After static training intervention, the foot posture index showed a decrease in the foot pronation. Conclusions: A 2-week gait retraining program with visual biofeedback was effective in lowering rearfoot plantar pressure, favoring better support of the arch index in recreational runners. In addition, static training was effective in reducing foot pronation. Most importantly, these observations will help healthcare professionals understand the importance of a gait retraining program with visual biofeedback to improve plantar loading and pronation during rehabilitation.
Ashley M.B. Suttmiller and Ryan S. McCann
Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.
Lorin A. Cartwright and Timothy Neal
An area that has not been closely considered in the sporting world is the mental health effects on the competitive athletes who identify as Lesbian, bisexual, gay, transgender, queer/questioning (LBGTQ+) and thus, experience discrimination because of their sexual identity. Considerations include concepts an athletic trainer should keep in mind when caring for patients/athletes who identify as LBGTQ+. This article reviews the mental health impact of sexual minority identity stress on LBGTQ+ individuals, steps to address discrimination for those in athletics who identify as LBGTQ+, legal ramifications in the workplace for the LBGTQ+ individual, and the tragic consequences when LBGTQ+ individuals lack coping skills for stress and pursue suicide as a way to cope. Strategies are provided to improve the outcomes, prevent suicide, and create an environment of inclusivity.
Andreas Kuettel, Natalie Durand-Bush, and Carsten H. Larsen
The purpose of this study was (a) to investigate gender differences in mental health among Danish youth soccer players, (b) to discover the mental health profiles of the players, and (c) to explore how career progression and mental health are related. A total of 239 Danish youth elite soccer players (M = 16.85, SD = 1.09) completed an online questionnaire assessing mental well-being, depression, anxiety, along with other background variables. Female players scored significantly lower on mental well-being and had four times higher odds of expressing symptoms of anxiety and depression than males. Athletes’ mental health profiles showed that most athletes experience low depression while having moderate mental well-being. Depression, anxiety, and stress scores generally increased when progressing in age, indicating that the junior–senior transition poses distinct challenges to players’ mental health, especially for female players. Different strategies to foster players’ mental health depending on their mental health profiles are proposed.
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.
Shawn R. Eagle, Patrick J. Sparto, Cynthia L. Holland, Abdulaziz A. Alkathiry, Nicholas A. Blaney, Hannah B. Bitzer, Michael W. Collins, Joseph M. Furman, and Anthony P. Kontos
Context: Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. Design: This case-control study compared 49 adolescent athletes aged 12–20 years with diagnosed SRC to 49 age- and sex-matched controls on visual–spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. Methods: The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. Results: Results supported significantly higher anterior–posterior (AP) sway values in concussed participants for visual–spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual–spatial discrimination (P = .01). Logistic regression analysis (R 2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = −2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. Conclusion: The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.
Sara Oliveira, Marina Cunha, António Rosado, and Cláudia Ferreira
This study aimed to test a model that hypothesized that the compassionate coach, as perceived by the athletes, has an impact on athlete-related social safeness and psychological health, through shame and self-criticism. The sample comprised 270 Portuguese adult athletes, who practiced different competitive sports. The path analysis results confirmed the adequacy of the proposed model, which explained 45% of the psychological health’s variance. Results demonstrated that athletes who perceive their coaches as more compassionate tend to present higher levels of social safeness (feelings of belonging to the team) and of psychological health, through lower levels of shame and self-criticism. These novel findings suggest the importance of the adoption of supportive, warm, safe, and compassionate attitudes from coaches in athletes’ mental health. This study also offers important insights by suggesting that feelings of acceptance and connectedness in team relationships may be at the root of athletes’ emotional processes and well-being.
Matthew Zaremba, Joel Martin, and Marcie Fyock-Martin
Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology.