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Olivia Bartlett and James L. Farnsworth II

Clinical Scenario: Kinesiophobia is a common psychological phenomenon that occurs following injury involving fear of movement. These psychological factors contribute to the variability among patients’ perceived disability scores following injury. In addition, the psychophysiological, behavioral, and cognitive factors of kinesiophobia have been shown to be predictive of a patient’s self-reported disability and pain. Previous kinesiophobia research has mostly focused on lower-extremity injuries. There are fewer studies that investigate upper-extremity injuries despite the influence that upper-extremity injuries can have on an individual’s activities of daily living and, therefore, disability scores. The lack of research calls for a critical evaluation and appraisal of available evidence regarding kinesiophobia and its contribution to perceived disability for the upper-extremity. Focused Clinical Question: How does kinesiophobia in patients with upper-extremity injuries influence perceptions of disability and quality of life measurements? Summary of Key Findings: Two cross-sectional studies and one cohort study were included. The first study found a positive relationship between kinesiophobia and a high degree of perceived disability. Another study found that kinesiophobia and catastrophic thinking scores were the most important predictors of perceived upper-extremity disability. The third study found that kinesiophobia contributes to self-reported disability in the shoulder. Clinical Bottom Line: There is moderate evidence that supports the relationship between kinesiophobia and perceived disability, and the relationship between elevated perceptions of disability and increased kinesiophobia scores in patients with an upper-extremity injury. Clinicians should evaluate and monitor kinesiophobia in patients following injury, a condition that can enhance perceptions of disability. An elevated perception of disability can create a cycle of fear that leads to hypervigilance and fear-avoidance behavior. Strength of Recommendation: Consistent findings from reviewed studies suggest there is grade B evidence to support that kinesiophobia is related to an increased perceived disability following upper-extremity injuries.

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Inmaculada Reina-Martin, Santiago Navarro-Ledesma, Ana Belen Ortega-Avila, Kevin Deschamps, Alfonso Martinez-Franco, Alejandro Luque-Suarez, and Gabriel Gijon-Nogueron

Background: Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. Objective: To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. Design: Cross-sectional and observational. Participants: The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). Results: Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). Conclusion: The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.

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Jeffrey B. Driban and Patrick O. McKeon

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Nicholas C. Clark and Elaine M. Mullally

Context: Single- versus double-leg landing events occur the majority of the time in a netball match. Landings are involved in large proportions of netball noncontact knee injury events. Of all landing-induced anterior cruciate ligament injuries, most occur during single-leg landings. Knowledge of whether different single-leg functional performance tests capture the same or different aspects of lower-limb motor performance will therefore inform clinicians’ reasoning processes and assist in netball noncontact knee injury prevention screening. Objective: To determine the correlation between the triple hop for distance (THD), single hop for distance (SHD), and vertical hop (VH) for the right and left lower limbs in adult female netball players. Design: Cross-sectional. Setting: Local community netball club. Participants: A total of 23 players (age 28.7 [6.2] y; height 171.6 [7.0] cm; mass 68.2 [9.8] kg). Interventions: There were 3 measured trials (right and left) for THD, SHD, and VH, respectively. Main Outcome Measures: Mean hop distance (percentage of leg length [%LL]), Pearson intertest correlation (r), and coefficient of determination (r 2). Results: Values (right and left; mean [SD]) were as follows: THD, 508.5 (71.8) %LL and 510.9 (56.7) %LL; SHD, 183.4 (24.6) %LL and 183.0 (21.5) %LL; and VH, 21.3 (5.2) %LL and 20.6 (5.0) %LL. All correlations were significant (P ≤ .05), r/r 2 values (right and left) were THD–SHD, .91/.83 and .87/.76; THD–VH, .59/.35 and .51/.26; and SHD–VH, .50/.25 and .37/.17. A very large proportion of variance (76%–83%) was shared between the THD and SHD. A small proportion of variance was shared between the THD and VH (25%–35%) and SHD and VH (17%–25%). Conclusion: The THD and SHD capture highly similar aspects of lower-limb motor performance. In contrast, the VH captures aspects of lower-limb motor performance different to the THD or SHD. Either the THD or the SHD can be chosen for use within netball knee injury prevention screening protocols according to which is reasoned as most appropriate at a specific point in time. The VH, however, should be employed consistently alongside rather than in place of the THD or SHD.

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Emilie N. Miley, Ashley J. Reeves, Madeline P. Casanova, Nickolai J.P. Martonick, Jayme Baker, and Russell T. Baker

Context: Total Motion Release® (TMR®) is a novel treatment paradigm used to restore asymmetries in the body (eg, pain, tightness, limited range of motion). Six primary movements, known as the Fab 6, are performed by the patient and scored using a 0 to 100 scale. Clinicians currently utilize the TMR® scale to modify treatment, assess patient progress, and measure treatment effectiveness; however, the reliability of the TMR® scale has not been determined. It is imperative to assess scale reliability and establish minimal detectable change (MDC) values to guide clinical practice. Objective: To assess the reliability of the TMR® scale and establish MDC values for each motion in healthy individuals in a group setting. Design: Retrospective analysis of group TMR® assessments. Setting: University classroom. Participants: A convenience sample of 61 students (23 males and 38 females; 25.48 [5.73] y), with (n = 31) and without (n = 30) previous exposure to TMR®. Intervention: The TMR® Fab 6 movements were tested at 2 time points, 2 hours apart. A clinician with previous training in TMR® led participant groups through both sessions while participants recorded individual motion scores using the 0 to 100 TMR® scale. Test–retest reliability was calculated using an intraclass correlation coefficient (2,1) for inexperienced, experienced, and combined student groups. Standard error of measurement and MDC values were also assessed for each intraclass correlation coefficient. Outcome Measure: Self-reported scores on the TMR® scale. Results: Test–retest reliability ranged from 0.57 to 0.95 across the Fab 6 movements, standard error of measurement values ranged from 4.85 to 11.77, and MDC values ranged from 13.45 to 32.62. Conclusion: The results indicate moderate to excellent reliability across the Fab 6 movements and a range of MDC values. Although this study is the first step in assessing the reliability of the TMR® scale for clinical practice, caution is warranted until further research is completed to establish reliability and MDC values of the TMR® scale in various settings to better guide patient care.

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Sarah Deck, Brianna DeSantis, Despina Kouali, and Craig Hall

In team sports, it has been found that team mistakes were reported as a stressor by both males and females, and at every playing level (e.g., club, university, national). The purpose of this study was to examine the impact of partners’ play on performance, emotions, and coping of doubles racquet sport athletes. Seventeen one-on-one semistructured interviews were conducted over the course of 6 months. Inductive and deductive analysis produced the main themes of overall impact on performance (i.e., positive, negative, or no impact), negative emotions (i.e., anger), positive emotions (i.e., excitement), emotion-focused coping (i.e., acceptance), and problem-focused coping (i.e., team strategy). These athletes acknowledge that how their partner plays significantly affects not only their emotions but also their own play and their choice of coping strategies. Future research should try to understand which forms of coping reduce the impact of partners’ play.