Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope™ ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope™ fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope™ syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope™ fixation system in place of the metallic screw following ankle syndesmosis injury.
Scott Benson Street, Matthew Rawlins, and Jason Miller
Tomoko Aoki and Koji Kadota
The present study examined the effects of daily activities of the hands on finger motor function in older adults. Maximum tapping frequency with each finger during single-finger tapping and alternate movements of index–middle, middle–ring, and ring–little finger pairs during double-finger tapping were compared between older adults who used their hands actively in their daily lives and those who did not. The active participants had significantly faster tapping rates for the ring finger in the single-finger tapping and the middle–ring finger pair in the double-finger tapping than did the inactive participants. Thus, daily activity of the hands in older adults could be effective at preventing the loss of dynamic motor function in individual fingers, especially with greater difficulty in movement, resulting from the degeneration with age.
Alexandre Nehring, Thiago Teixeira Serafim, Elisa Raulino Silva, Fábio Sprada de Menezes, Nicola Maffulli, Luciana Sayuri Sanada, and Rodrigo Okubo
Context: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. Objective: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. Design: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. Setting: Institutional physiotherapy clinic. Participants: A total of 40 university students (18–30 y), who had no symptoms, participated. Intervention: Foam roller for 30 seconds and 2 minutes for group 2. Main Outcome Measures: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. Results: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. Conclusions: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.
Gemma N. Parry, Lee C. Herrington, Ian G. Horsley, and Ian Gatt
Context: Maximal power describes the ability to immediately produce power with the maximal velocity at the point of release, impact, and/or take off—the greater an athlete’s ability to produce maximal power, the greater the improvement of athletic performance. In reference to boxing performance, regular consistent production of high muscular power during punching is considered an essential prerequisite. Despite the importance of upper limb power to athletic performance, presently, there is no gold standard test for upper limb force development performance. Objective: To investigate the test–retest reliability of the force plate–derived measures of countermovement push-up in elite boxers. Design: Test–retest design. Setting: High Performance Olympic Training Center. Participants: Eighteen elite Olympic boxers (age = 23  y; height = 1.68 [0.39] m; body mass = 70.0  kg). Intervention: Participants performed 5 repetitions of countermovement push-up trials on FD4000 Forcedeck dual force platforms on 2 separate test occasions 7 days apart. Main Outcome Measures: Peak force, mean force, flight time, rate of force development, impulse, and vertical stiffness of the bilateral and unilateral limbs from the force–time curve. Results: No significant differences between the 2 trial occasions for any of the derived bilateral or unilateral performance measures. Intraclass correlation coefficients indicated moderate to high reliability for performance parameters (intraclass correlation coefficients = .68–.98) and low coefficient of variation (3%–10%) apart from vertical stiffness (coefficient of variation = 16.5%–25%). Mean force demonstrated the greatest reliability (coefficient of variation = 3%). In contrast, no significant differences (P < .001) were noted between left and right limbs (P = .005–.791), or between orthodox or southpaw boxing styles (P = .19–.95). Conclusion: Force platform–derived kinetic bilateral and unilateral parameters of countermovement push-up are reliable measures of upper limb power performance in elite-level boxers; results suggest unilateral differences within the bilateral condition are not the norm for an elite boxing cohort.
Nilüfer Kablan, Nuray Alaca, and Yaşar Tatar
Context: Fast and adequate recovery after exercise and activity is important for increasing performance and preventing injuries. Inadequate recovery usually causes changes in the biomechanical and viscoelastic properties of the muscle. Objective: To compare the immediate effect of petrissage massage (PM) and manual lymph drainage (MLD) following submaximal exercise on the biomechanical and viscoelastic properties of the rectus femoris muscle in healthy women. Design: Cross-sectional, repeated-measures. Setting: Marmara University. Participants: 18 healthy female students. Intervention(s): Following the submaximal quadriceps strengthening exercise performed in 3 sets of 8 repetitions with intensity of 75% of 1 maximum repetition, participants’ right leg received a 5-minute PM (PM group) and the contralateral leg received a 5-minute MLD application (MLD group). Main Outcome Measures: Skin temperature was measured using P45 thermographic thermal camera (Flir System; ThermaCAM, Danderyd, Sweden), and muscle tone, biomechanical, and viscoelastic features were measured with a myometer (Myoton AS, Tallinn, Estonia) at baseline, immediately postexercise, post-PM/MLD application, and 10 minutes postexercise. Results: In the PM group, the tonus (P = .002) and stiffness (P < .001) values measured after the massage and at the end of the 10-minute resting period were found to be statistically different than those measured right after the exercise (P < .05). Relaxation time and creep values at all measurement times were significantly different (P < .05). In the MLD group, it was observed the tonus (P < .001), stiffness (P = .025), and relaxation time (P < .01) values decreased significantly after the MLD compared with the values measured after the exercise; however, the creep value was found to be significantly different in all measurements (P < .05). Conclusion: PM and MLD reduce passive tissue stiffness and improve the extent of muscle extensibility over time against the muscle tensile strength. PM and MLD are therapeutic methods that can be used to support tissue recovery after exercise and prevent injuries.
Matías Henríquez, Aitor Iturricastillo, Arturo González-Olguín, Felipe Herrera, Sonny Riquelme, and Raul Reina
This study compared physical performance in a group of international cerebral palsy football players during two formats of small-sided games (SSGs) and performance in a simulated game (SG) according to players’ sport classes (FT1, FT2, and FT3). Internal load (heart rate and rating of perceived exertion) and external load (total distance, distance covered at different velocities, maximum speed reached, acceleration, and deceleration) were obtained with global positioning system devices during two formats of SSGs (2-a-side/SSG2 and 4-a-side/SSG4) and an SG (7-a-side). SSG2 demands faster actions compared with SSG4/SG, and significant differences and large effect sizes were found in the distance covered in Speed Zones 5 (16.0−17.9 km/hr) and 6 (>18.0 km/hr; p < .05;
Dhinu J. Jayaseelan, Cesar Fernandez-de-las-Penas, Taylor Blattenberger, and Dean Bonneau
Clinical Scenario: Plantar heel pain is a common condition frequently associated with persistent symptoms and functional limitations affecting both the athletic and nonathletic populations. Common interventions target impairments at the foot and ankle and local drivers of symptoms. If symptoms are predominantly perpetuated by alterations in central pain processing, addressing peripheral impairments alone may not be sufficient. Clinical Question: Do individuals with chronic plantar heel pain demonstrate signs potentially associated with altered central pain processing? Summary of Key Findings: After searching 6 electronic databases (PubMed, CINAHL, Scopus, SportDiscus, Cochrane, and PEDro) and filtering titles based on predetermined inclusion and exclusion criteria, 4 case-control studies were included. All studies scored highly on the Newcastle-Ottawa Scale for quality assessment. Using pressure pain thresholds, each study found decreased pressure pain hypersensitivity locally and at a remote site compared to control groups, suggesting the presence, to some extent, of altered nociceptive pain processing. Clinical Bottom Line: In the studies reviewed, reported results suggest a possible presence of centrally mediated symptoms in persons with plantar heel pain. However, despite findings from these studies, limitations in appropriate matching based on body mass index and measures used suggest additional investigation is warranted. Strength of Recommendation: According to the Oxford Centre for Evidence-Based Medicine, there is evidence level C to suggest chronic plantar heel pain is associated with alterations in central pain processing.
Matthew K. Seeley, Seong Jun Son, Hyunsoo Kim, and J. Ty Hopkins
Context: Patellofemoral pain (PFP) is often categorized by researchers and clinicians using subjective self-reported PFP characteristics; however, this practice might mask important differences in movement biomechanics between PFP patients. Objective: To determine whether biomechanical differences exist during a high-demand multiplanar movement task for PFP patients with similar self-reported PFP characteristics but different quadriceps activation levels. Design: Cross-sectional design. Setting: Biomechanics laboratory. Participants: A total of 15 quadriceps deficient and 15 quadriceps functional (QF) PFP patients with similar self-reported PFP characteristics. Intervention: In total, 5 trials of a high-demand multiplanar land, cut, and jump movement task were performed. Main Outcome Measures: Biomechanics were compared at each percentile of the ground contact phase of the movement task (α = .05) between the quadriceps deficient and QF groups. Biomechanical variables included (1) whole-body center of mass, trunk, hip, knee, and ankle kinematics; (2) hip, knee, and ankle kinetics; and (3) ground reaction forces. Results: The QF patients exhibited increased ground reaction force, joint torque, and movement, relative to the quadriceps deficient patients. The QF patients exhibited: (1) up to 90, 60, and 35 N more vertical, posterior, and medial ground reaction force at various times of the ground contact phase; (2) up to 4° more knee flexion during ground contact and up to 4° more plantarflexion and hip extension during the latter parts of ground contact; and (3) up to 26, 21, and 48 N·m more plantarflexion, knee extension, and hip extension torque, respectively, at various times of ground contact. Conclusions: PFP patients with similar self-reported PFP characteristics exhibit different movement biomechanics, and these differences depend upon quadriceps activation levels. These differences are important because movement biomechanics affect injury risk and athletic performance. In addition, these biomechanical differences indicate that different therapeutic interventions may be needed for PFP patients with similar self-reported PFP characteristics.
Sean Sanford, Mingxiao Liu, and Raviraj Nataraj
Context: Continuous visual feedback (VF) can improve abilities to achieve desired movements and maximize rehabilitation outcomes by displaying actual versus target body positions in real time. Bandwidth VF reduces the reliance on feedback by displaying movement cues only when performance errors exceed specified thresholds. As such, bandwidth VF may better train independent movement abilities through greater development of intrinsic body control. In this study, continuous and bandwidth VF were investigated across modes of display (abstract and representative) that differed in body-discernibility. Objective: To compare the performance of the 2-legged squat during training with concurrent feedback (real-time VF) and short-term retention (immediately after training, VF removed). Design: Cross-sectional. Setting: University research laboratory. Participants: Eighteen healthy individuals. Methods: Marker-based motion capture displayed real-time position. Main Outcome Measures: Four VF cases (continuous–abstract, bandwidth–abstract, continuous–representative, and bandwidth–representative) were evaluated for accuracy and consistency to a target trajectory and target depth. Results: During training, both continuous VF cases showed significantly (P < .05) higher accuracy and consistency to the target trajectory compared with both bandwidth VF cases. Bandwidth VF resulted in greater potential learning (retention performance relative to a training baseline) compared with continuous–abstract. Conclusions: Continuous–representative may offer unique performance benefits in both training and retention of multisegment movement tasks. Bandwidth VF showed greater potential for learning. For long-term learning, an optimal VF paradigm should consider continuous–representative with bandwidth features.