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Pablo Fanlo-Mazas, Elena Bueno-Gracia, Alazne Ruiz de Escudero-Zapico, Carlos López-de-Celis, César Hidalgo-García, Jacobo Rodríguez-Sanz, and María Orosia Lucha-López

Context: Localized and widespread hyperalgesia has been observed in patients with patellofemoral pain. Diacutaneous fibrolysis (DF) has shown to be effective in reducing pain in several musculoskeletal conditions including patellofemoral pain syndrome, but no studies have evaluated the effects of this technique in reducing localized and widespread hyperalgesia. Objective: To assess the effect of DF on the pressure pain threshold and muscle length tests in patients with patellofemoral pain syndrome. Design: A single-group, pretest–posttest clinical trial. Setting: University of Zaragoza. Participants: Forty-six subjects with patellofemoral pain (20 males and 26 females: age 27.8 [6.9] y). Intervention: Three sessions of DF. Main Outcome Measures: Pressure pain threshold using a handheld pressure algometer (4 sites around the knee, on tibialis anterior muscle, and one remote site on the upper contralateral limb); muscle length test of the iliotibial band, rectus femoris, and hamstring muscles; and patient-perceived treatment effect score. Results: The application of 3 sessions of DF significantly increased the pressure pain threshold in all sites at posttreatment evaluation (P < .001) and at a 1-week follow-up (P < .001). A significant increase in muscle length was also observed at the posttreatment evaluation (P < .001) and 1-week follow-up (P < .001). Ninety-seven percent of the patients reported subjective improvement at posttreatment and at 1-week follow-up. Conclusion: This study found that local and widespread hyperalgesia was significantly reduced after 3 sessions of diacutaneous fibrolysis and at the 1-week follow-up. A significant improvement on muscle length tests was also observed, with high clinical satisfaction among patients.

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Laura Prieto, Michael L. Norris, and Luis Columna

The purpose of this study was to examine the experiences of people with Parkinson’s (PwP) and their care partners (CPs) who participated in a Parkinson’s-focused community dance class in a northeastern state of the United States. In this qualitative inquiry, participants included five PwP and their respective CPs (n = 5). Three major, recurrent, and interrelated themes emerged from the data. These themes were (a) keep moving, (b) compassion in action, and (c) acceptance and freedom in dance. These themes captured personal and environmental factors that influenced the participation of PwP and their CPs in a dance class and how they perceived that dance influenced their quality of life. The themes described the obstacles, motives, and perceived outcomes of participating in dance. The findings emphasize the need for future dance interventions and programs that consider the CPs’ role in promoting participation for PwP in dance classes.

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Kyoungyoun Park-Braswell, Sandra J. Shultz, and Randy J. Schmitz

Context: Greater anterior knee laxity (AKL) is associated with impaired sensory input and decreased functional knee stability. As functional magnetic resonance imaging (MRI) is the gold standard for understanding brain function, methods to load the anterior cruciate ligament in the MRI environment could further our understanding of the ligament’s sensory role in knee joint stability. Objective: To design and validate an MRI-compatible anterior knee joint loading device. Design: Descriptive laboratory study. Setting: University laboratory study. Participants: Sixteen healthy and physically active females participated (age = 23.4 [3.7] y; mass = 64.4 [8.4] kg). Interventions: The AKL was assessed by a commercially available arthrometer. The AKL was also assessed with a custom-made, MRI-compatible device that produced anterior knee joint loading in a manner similar to the commercial arthrometer while obtaining dynamic structural MRI data. Main Outcome Measurements: The AKL (in millimeters) at 133 N of loading was assessed with the commercial knee arthrometer. Anterior displacement of the tibia relative to the femur obtained at 133 N of loading was measured from dynamic MRI data obtained during usage of the custom device. Pearson correlations were used to examine relationships between the 2 measures. The 95% limits of agreement compared the absolute differences between the 2 devices. Results: There was a 3.2-mm systematic difference between AKL (6.3 [1.6] mm) and anterior tibial translation (3.2 [1.0] mm) measures. There was a significant positive correlation between values obtained from the commercial arthrometer and the MRI-compatible device values (r = .553, P = .026). Conclusions: While systematic differences were observed, the MRI-compatible anterior knee joint loading device anteriorly translated the tibia relative to the femur in a similar manner to a commercial arthrometer design to stress the anterior cruciate ligament. Such a device may be beneficial in future functional magnetic resonance imaging study of anterior cruciate ligament mechanoreception.

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Adesola C. Odole, Olawale T. Agbomeji, Ogochukwu K.K. Onyeso, Joshua O. Ojo, and Nse A. Odunaiya

Background: Athletes’ perceptions toward physiotherapy services have an impact on their general attitude toward these services and their willingness to work together with physiotherapists for rehabilitation. The study investigated athletes’ perspectives of physiotherapy services in sports injury management. Methods: A mixed-study design of a cross-sectional survey that involved 178 conveniently sampled athletes and an explanatory qualitative study (8 purposively-selected athletes) was used. The authors assessed the participants’ knowledge and perception of physiotherapy services using the modified versions of the Athletes’ Level of Knowledge Questionnaire, Matsuno Athletes Perception Scale, and focus group discussion. The data were analyzed using chi-square, Spearman correlation at P ≤ .05, and deductive reasoning thematic analysis. Results: The age of the participants for the cross-sectional survey (131 men and 47 women) was 22.50 (7.51) years. Our results showed that the majority (91.6%) of them had adequate knowledge and (78.7%) positive perception about the role physiotherapists play in sports injury management. The participants’ knowledge of physiotherapy services had a significantly positive correlation with age (ρ = .12; P = .01), sporting years (ρ = .17; P = .02), and duration in sports council (ρ = .19; P = .01), while their perception showed a negative correlation with age (ρ = −.15; P = .05), sporting years (ρ = −.16; P = .03), and duration in sports council (ρ = −.08; P = .02). However, no significant correlation existed between the participants’ knowledge; perception and level of education; level of competition; type of sport; and type, nature, and severity of sport injury. Seven themes were generated from the focus group discussion. Conclusion: The participants reported adequate knowledge and a positive perception of physiotherapy services. The correlates of participants’ knowledge and perception of physiotherapy services are age, sporting years, and duration in the sports council. From the qualitative component of the study, the authors identified the need to provide more physiotherapy services to athletes and more facilities for physiotherapy services.

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Luca Cavaggioni, Athos Trecroci, Damiano Formenti, Luke Hogarth, Massimiliano Tosin, and Giampietro Alberti

The purpose of this study was to monitor the changes in breathing pattern, trunk muscle stabilization, and upper-body muscular power in Paralympic swimmers throughout a competitive season over three time points: October (T1), March (T2), and August (T3). Six top-level Paralympic swimmers voluntarily participated in this study. The Friedman test, the Bonferroni–Dunn multiple comparison post hoc analysis, and Kendall’s W concordance coefficient for the measure of effect were used. A significant difference was found in the breathing pattern, trunk stability, and upper-body power variables from the T1 to T3 season (p < .05). However, no significant changes were found in the T2 season. A long-term assessment of these fitness parameters may be of practical importance for better tailoring the training programs of top-level Paralympic swimmers.

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Gopal Nambi, Walid Kamal Abdelbasset, Saud F. Alsubaie, Ayman K. Saleh, Anju Verma, Mohamed A. Abdelaziz, and Abdulaziz A. Alkathiry

Objective: To find the short-term psychological and hormonal effects of virtual reality training on chronic low back pain in American soccer players. Design, Setting, Participants: The 3-block random sampling method was used on 54 university American soccer players with chronic low back pain, and they were allocated into 3 groups: virtual reality training (VRT; n = 18), combined physical rehabilitation (n = 18), and control (n = 18) groups at University Hospital. They underwent different balance training exercises for 4 weeks. The participants and the therapist who is assessing the outcomes were blinded. Psychological (pain intensity and kinesiophobia) and hormonal (glucose, insulin, Homeostatic Model Assessment of Insulin Resistance, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) values were measured at baseline, after 4 weeks, and after 6 months. Results: The baseline demographic, psychological, and hormonal data between the VRT, combined physical rehabilitation, and control groups show no statistical difference (P ≥ .05). Four weeks following training, the VRT group shows more significant changes in pain intensity and kinesiophobia than the combined physical rehabilitation and control groups (P < .001), and the improvement was noted in the 6-month follow-up. All the hormonal variables (glucose, insulin, growth hormone, prolactin, adrenocorticotropic hormone, and cortisol) show significant changes at 4-week training (P < .001), except for the Homeostatic Model Assessment of Insulin Resistance (P = .075) between the 3 groups. At 6-month follow-up glucose, prolactin, adrenocorticotropic hormone, and cortisol show more significant difference in the VRT group than the other 2 groups (P < .001). At the same time, insulin (P = .694), Homeostatic Model Assessment of Insulin Resistance (P = .272), and growth hormone (P = .145) failed to show significant changes between the groups. Conclusion: Training through virtual reality is an effective treatment program when compared with conventional exercise training programs from a psychological and hormonal analysis perspective in American soccer players with chronic low back pain.

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Rachel K. Straub, Adam J. Barrack, Jordan Cannon, and Christopher M. Powers

Context: A limitation of previous studies on squatting mechanics is that the influence of trunk and shank inclination on the knee-extensor moment (KEM) has been studied in isolation. Objective: The purpose of the current study was to determine the influence of segment orientation on the KEM during freestanding barbell squatting. Design: Repeated-measures cross sectional. Setting: University research laboratory. Participants: Sixteen healthy individuals (8 males and 8 females). Intervention: Each participant performed 8 squat conditions in which shank and trunk inclinations were manipulated. Main Outcome Measures: 3D kinematic and kinetic data were collected at 250 and 1500 Hz, respectively. Regression analysis was conducted to identify the individual relationships between the KEM and the trunk and shank inclination at 60° and 90° of knee flexion. To identify the best predictor(s) of the KEM, stepwise regression was implemented. Results: Increased shank inclination increased the KEM (P < .001, R 2 = .21–.25). Conversely, increased trunk inclination decreased the KEM (P < .001, R 2 = .49–.50). For the stepwise regression, trunk inclination entered first and explained the greatest variance in the KEM (all P < .001, R 2 = .49–.50). Shank inclination entered second (all P < .010, R 2 = .53–.54) and explained an additional 3% to 5% of the variance. Conclusions: Our results confirm that inclination of the trunk and shank have an opposing relationship with the KEM. Increased forward shank posture increases the KEM, while increased forward trunk posture decreases the KEM. However, when viewed in combination, the trunk was the superior predictor of the KEM, highlighting the fact that increased quadriceps demand created by a forward shank can be offset by trunk inclination.

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Rihab Borji, Firas Zghal, Nidhal Zarrouk, Sonia Sahli, and Haithem Rebai

The authors explored neuromuscular fatigue in athletes with intellectual disability (AID) compared with sedentary individuals with intellectual disability (SID) and individuals with typical development. Force, voluntary activation level, potentiated resting twitch, and electromyography signals were assessed during isometric maximal voluntary contractions performed before and immediately after an isometric submaximal exhaustive contraction (15% isometric maximal voluntary contractions) and during recovery period. AID presented shorter time to task failure than SID (p < .05). The three groups presented similar isometric maximal voluntary contraction decline and recovery kinetic. Both groups with intellectual disability presented higher voluntary activation level and root mean square normalized to peak-to-peak M-wave amplitude declines (p < .05) compared with individuals with typical development. These declines were more pronounced in SID (p < .05) than in AID. The AID recovered their initial voluntary activation level later than controls, whereas SID did not. SID presented lower potentiated resting twitch decline compared with AID and controls with faster recovery (p < .05). AID presented attenuated central fatigue and accentuated peripheral fatigue compared with their sedentary counterparts, suggesting a neuromuscular profile close to that of individuals with typical development.

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Megan Wagner and Kevin D. Dames

Context: Bodyweight-supporting treadmills are popular rehabilitation tools for athletes recovering from impact-related injuries because they reduce ground reaction forces during running. However, the overall metabolic demand of a given running speed is also reduced, meaning athletes who return to competition after using such a device in rehabilitation may not be as fit as they had been prior to their injury. Objective: To explore the metabolic effects of adding incline during bodyweight-supported treadmill running. Design: Cross-sectional. Setting: Research laboratory. Participants: Fourteen apparently healthy, recreational runners (6 females and 8 males; 21 [3] y, 1.71 [0.08] m, 63.11 [6.86] kg). Interventions: The participants performed steady-state running trials on a bodyweight-supporting treadmill at 8.5 mph. The control condition was no incline and no bodyweight support. All experimental conditions were at 30% bodyweight support. The participants began the sequence of experimental conditions at 0% incline; this increased to 1%, and from there on, 2% incline increases were introduced until a 15% grade was reached. Repeated-measures analysis of variance was used to compare all bodyweight-support conditions against the control condition. Main Outcome Measures: Oxygen consumption, heart rate, and rating of perceived exertion. Results: Level running with 30% bodyweight support reduced oxygen consumption by 21.6% (P < .001) and heart rate by 12.0% (P < .001) compared with the control. Each 2% increase in incline with bodyweight support increased oxygen consumption by 6.4% and heart rate by 3.2% on average. A 7% incline elicited similar physiological measures as the unsupported, level condition. However, the perceived intensity of this incline with bodyweight support was greater than the unsupported condition (P < .001). Conclusions: Athletes can maintain training intensity while running on a bodyweight-supporting treadmill by introducing incline. Rehabilitation programs should rely on quantitative rather than qualitative data to drive exercise prescription in this modality.

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Raki Kawama, Masamichi Okudaira, David H. Fukuda, Hirohiko Maemura, and Satoru Tanigawa

Context: Each hamstring muscle is subdivided into several regions by multiple motor nerve branches, which implies each region has different muscle activation properties. However, little is known about the muscle activation of each region with a change in the knee joint angle. Understanding of regional activation of the hamstrings could be helpful for designing rehabilitation and training programs targeted at strengthening a specific region. Objective: To investigate the effect of knee joint angle on the activity level of several regions within the individual hamstring muscles during isometric knee-flexion exercise with maximal effort (MVCKF). Design: Within-subjects repeated measures. Setting: University laboratory. Participants: Sixteen young males with previous participation in sports competition and resistance training experience. Intervention: The participants performed 2 MVCKF trials at each knee joint angle of 30°, 60°, and 90°. Outcome Measures: Surface electromyography was used to measure muscle activity in the proximal, middle, and distal regions of the biceps femoris long head (BFlh), semitendinosus, and semimembranosus of hamstrings at 30°, 60°, and 90° of knee flexion during MVCKF. Results: Muscle activity levels in the proximal and middle regions of the BFlh were higher at 30° and 60° of knee flexion than at 90° during MVCKF (all: P < .05). Meanwhile, the activity levels in the distal region of the BFlh were not different among all of the evaluated knee joint angles. In semitendinosus and semimembranosus, the activity levels were higher at 30° and 60° than at 90°, regardless of region (all: P < .05). Conclusion: These findings suggest that the effect of knee joint angle on muscle activity level differs between regions of the BFlh, whereas that is similar among regions of semitendinosus and semimembranosus during MVCKF.