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Open access

Ling Zhang, Shao-bai Wang, Shuai Fan, Jiling Ye, and Bin Cai

Context: Performance in strength and assessment of patellar tracking is important for patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction. Objective: The study was to examine the difference of patellofemoral kinematics between the affected and the contralateral limb and to evaluate the relationship between knee extensor strength and patellofemoral kinematics in patients with arthrofibrosis after ACL reconstruction. Design: Cohort study (diagnosis); level of evidence, 3. Setting: Laboratory. Patients: A prospective cohort of 20 patients with arthrofibrosis after ACL reconstruction was recruited. Interventions: A total of 20 patients who underwent arthroscopic reconstruction of the double-bundle ACL with a hamstring tendon autograft received standardized patellofemoral kinematics testing and knee extensor strength testing within 6 months after primary ACL reconstruction. Computed tomography and dual fluoroscopic imaging were used to evaluate in vivo patellofemoral kinematics of affected and contralateral knees during a lunge task. Knee extensor mechanism strength was measured using a handheld dynamometer. Main Outcome Measures: A limb symmetry index of knee strength and patellar mobility was calculated and satisfactory performance defined as ≥90%. Results: There was a statistically significant decrease in the range of patellar inferior shift (P = .020; d = 0.81), flexion (P = .026; d = 0.95), lateral tilt (P = .001; d = 1.04), and lateral rotation (P < .001; d = 0.89) in the affected knee compared with the contralateral knee from 15° to 75° of knee flexion. There was a strong positive linear correlation between knee extensor strength and patellar inferior shift (r = .747; P = .008). A knee extensor strength limb symmetry index <90% was 89% sensitive and 9% specific for limited patellar inferior shift. Conclusions: Patients with arthrofibrosis after ACL reconstruction presented decreased patellar mobility in the arthrofibrotic knee compared with the contralateral knee. The strong correlation between knee extensor strength and patellar inferior shift of the arthrofibrotic knee demonstrates the importance of knee extensor strength in the diagnosis and treatment of patients with knee arthrofibrosis. The knee extensor mechanism strength has high sensitivity but low specificity in identifying a decrease in patellar inferior shift in patients with arthrofibrosis after ACL reconstruction.

Open access

Jessica Murphy, Karen A. Patte, Philip Sullivan, and Scott T. Leatherdale

The mental health benefits of physical activity may relate more to the context of the behavior, rather than the behavior of being active itself. The association between varsity sport (VS) participation, depression, and anxiety symptoms was explored using data from 70,449 high school students from the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behavior study. The model adjusted for potential covariates; interactions by sex and participation in outside of school sport (OSS) were explored. Overall, 70% and 24% of respondents met or exceeded cutoff values for depression and anxiety, respectively. Students participating in VS had lower symptoms of anxiety and depression compared with nonparticipants. Results were consistent regardless of OSS participation; associations were strongest among students who participated in both VS and OSS and males. Participation in VS may prove beneficial for the prevention and/or management of depression or anxiety symptoms, particularly among males. An additive beneficial effect of OSS on depression and anxiety scores may exist.

Open access

Jamon Couch, Marc Sayers, and Tania Pizzari

Context: An imbalance between shoulder internal rotation (IR) and external rotation (ER) strength in athletes is proposed to increase the risk of sustaining a shoulder injury. Hand-held (HHD) and externally fixed dynamometry are reliable forms of assessing shoulder IR and ER strength. A new externally fixed device with an attachable fixed upper-limb mold (The ForceFrame) exists; however, its reliability in measuring shoulder strength is yet to be investigated. Objective: To determine the test–retest reliability of the ForceFrame, with and without the fixed upper-limb mold, in the assessment of shoulder IR and ER strength, as compared with HHD. Design: Test–retest reliability study. Setting: Laboratory, clinical. Participants: Twenty-two healthy and active individuals were recruited from the university community and a private physiotherapy practice. Main Outcome Measures: Maximal isometric shoulder IR and ER strength was measured using the ForceFrame and traditional HHD in neutral and at 90° shoulder abduction. Mean (SD) strength measures were calculated. Test–retest reliability was analyzed using intraclass correlation coefficients (3, 1). The SEM and minimal detectable change were calculated. Results: Good to excellent test–retest reliability was found for all shoulder strength tests across HDD and ForceFrame dynamometry (intraclass correlation coefficients [3, 1]  = .854–.916). The minimal detectable changes ranged between 25.61 and 41.84 N across tests. Test–retest reliability was not affected by the dynamometer or testing position. Conclusions: The results from this study indicate that both the ForceFrame and HHD are suitable for measuring shoulder strength in clinical practice. The use of the fixed upper-limb mold with the ForceFrame does not improve reliability.

Open access

Nickolai J.P. Martonick, Ashley J. Reeves, James A. Whitlock, Taylor C. Stevenson, Scott W. Cheatham, Craig P. McGowan, and Russell T. Baker

Context: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. Objective: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. Design: Experimental. Setting: University research laboratory. Participants: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). Intervention: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. Main Outcome Measures: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. Results: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. Conclusions: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes.

Open access

Gabriel dos Santos Oliveira, João Breno de Araujo Ribeiro-Alvares, Felipe Xavier de Lima-e-Silva, Rodrigo Rodrigues, Marco Aurélio Vaz, and Bruno Manfredini Baroni

Context: Eccentric knee flexor strength assessments have a key role in both prevention and rehabilitation of hamstring strain injuries. Objective: To verify the reliability of a clinical test for measuring eccentric knee flexor strength during the Nordic hamstring exercise using a commercially available handheld dynamometer. Design: Reliability study. Setting: Physical Therapy Laboratory, Federal University of Health Sciences of Porto Alegre (Brazil). Participants: Fifty male amateur athletes (soccer or rugby players; 24 [3] y). Main Outcome Measures: Eccentric knee flexor strength. Results: When compared with a load cell–based device, the clinical test using a handheld dynamometer provided smaller force values (P < .05) with large effect sizes (.92–1.21), moderate intraclass correlation (.60–.62), typical error of 30 to 31 N, and coefficient of variation of 10% to 11%. Regarding the test–retest reproducibility (2 sessions separated by 1 week), the clinical test provided similar force values (P > .05) with only small effect sizes (.20–.27), moderate to good correlation (.67–.76), typical error of 23 to 24 N, and coefficient of variation of 9% to 10%. Conclusion: The clinical test with handheld dynamometer proposed by this study can be considered an affordable and relatively reliable tool for eccentric knee flexor strength assessment in the clinical setting, but results should not be directly compared with those provided by load cell–based devices.

Open access

Aaron Byrne, Clare Lodge, and Jennifer Wallace

Context: Single-leg stability has been associated with injury risk and is a key component of many injury prevention interventions. Methods of measuring single-leg stability are varied yet often unreliable. Objective: To establish within- and between-day test–retest reliability for single-leg time to stabilization (SL-TTS) following a drop-landing maneuver of 20 cm in height among a healthy cohort. Design: Test–retest reliability study. Setting: Healthy cohort from a third-level educational institution. Participants: Nineteen (11 females and 8 males) healthy individuals. Main Outcome Measures: The SL-TTS in the vertical plane. Results: The SL-TTS showed good within-day (intraclass correlation coefficient = .715) and excellent between-day (intraclass correlation coefficient = .83) test–retest reliability. The minimal detectable change was calculated as 171.6 ms for within-day contexts and 123.8 ms for between-day contexts. Conclusions: This method of measuring SL-TTS is reliable and could be used to detect changes over time in a healthy cohort. This could be of value to clinicians in injury risk factor identification or assessing the effectiveness of single-leg stability training. However, further research is needed to investigate its reliability in pathological populations.

Open access

Jennifer L. Ostrowski, Alexa Beaumont, and Emily Dochterman

Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.

Open access

Samar Ezzina, Clément Roume, Simon Pla, Hubert Blain, and Didier Delignières

The analysis of stride series revealed a loss of complexity in older people, which correlated with the falling propensity. A recent experiment evidenced an increase of walking complexity in older participants when they walked in close synchrony with a younger companion. Moreover, a prolonged experience of such synchronized walking yielded a persistent restoration of complexity. This result, however, was obtained with a unique healthy partner, and it could be related to a particular partner’s behavior. The authors’ aim was to replicate this important finding using a different healthy partner and to compare the results to those previously obtained. The authors successfully replicated the previous results: synchronization yielded an attraction of participants’ complexity toward that of their partner and a restoration of complexity that persisted in two posttests, 2 and 6 weeks after the end of the training sessions. This study shows that this complexity restoration protocol can be applied successfully with another partner, and allows us to conclude that it can be generalized.

Open access

Félix Croteau, Shawn M. Robbins, and David Pearsall

Context: Previous authors suggest that lack of strength is an important risk factor for injuries in water polo. Hand-held dynamometers have potential as a clinical tool to measure strength, but they have not been validated in water polo players. Objective: The purpose of this study was to estimate intertrial variability and concurrent validity of hand-held dynamometer shoulder strength measurements in elite water polo players. Methods: A total of 19 male and 20 female elite water polo players performed isometric external (ER) and internal (IR) rotation strength tests against a hand-held dynamometer bilaterally in supine position with the shoulder in a 90–90 position. In addition, concentric IR and ER was captured at 90 deg/s with an isokinetic dynamometer, and torque values were determined near the 90–90 position. Main Outcome Measures: Spearman correlation coefficients were calculated for ER torque, IR torque, and ER/IR ratios between the devices. Two-way mixed-model intraclass correlations were used to assess intertrial variability. Results: Correlations between the devices were strong to very strong (ρ = .65–.82, P < .01) for absolute IR and ER but low for ER/IR ratios (ρ = .29, P = .07). There was less agreement at higher torque values. Intertrial variability was low with intraclass correlation values .88 to .93, P < .05. Conclusions: These results show that hand-held dynamometers are adequate clinical alternatives to measure absolute shoulder strength in water polo players. Stronger players may require stronger evaluators to resist the player’s push and obtain reliable results.

Open access

Robert C. Lynall, Rachel S. Johnson, Landon B. Lempke, and Julianne D. Schmidt

Context: Reaction time is commonly assessed postconcussion through a computerized neurocognitive battery. Although this measure is sensitive to postconcussion deficits, it is not clear if computerized reaction time reflects the dynamic reaction time necessary to compete effectively and safely during sporting activities. Functional reaction time assessments may be useful postconcussion, but reliability must be determined before clinical implementation. Objective: To determine the test–retest reliability of a functional reaction time assessment battery and to determine if reaction time improved between sessions. Design: Cohort. Setting: Laboratory. Participants: Forty-one participants (21 men and 20 women) completed 2 time points. Participants, on average, were 22.5 (2.1) years old, 72.5 (11.9) cm tall, had a mass of 71.0 (13.7) kg, and were mostly right leg and hand dominant (92.7%). Interventions: Participants completed 2 clinical reaction time tests (computerized Stroop and drop stick) and 5 functional reaction time tests (gait, jump landing, single-leg hop, anticipated cut, and unanticipated cut) across 2 sessions. Drop stick and functional reaction time assessments were performed in single (motor task only) and dual task (motor task with cognitive task). Main Outcome Measures: Reaction time (in seconds) was calculated during all assessments. Test–retest reliability was determined using 2-way mixed-effects intraclass correlation coefficients (3, k). Paired samples t tests compared mean reaction time between sessions. Results: Test–retest reliability was moderate to excellent for all reaction time outcomes (intraclass correlation coefficients [3, k] range = .766–.925). Several statistically significant between-session mean differences were observed, but effect sizes were negligible to small (d range = 0.05–0.44). Conclusions: The functional reaction time assessment battery displayed similar reliability to the standard computerized reaction time assessment battery and may provide important postinjury information, but more research is needed to determine clinical utility.