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Denys Batista Campos, Isabella Christina Ferreira, Matheus Almeida Souza, Macquiden Amorim Jr, Leonardo Intelangelo, Gabriela Silveira-Nunes, and Alexandre Carvalho Barbosa

Objective: To examine the selective influences of distinct acceleration profiles on the neuromuscular efficiency, force, and power during concentric and eccentric phases of isoinertial squatting exercise. Design: Cross-sectional study. Setting: Biomechanics laboratory of the university. Participants: A total of 38 active adults were divided according to their acceleration profiles: higher (n = 17; >2.5 m/s2) and lower acceleration group (n = 21; <2.5 m/s2). Intervention: All subjects performed squats until failure attached to an isoinertial conic pulley device monitored by surface electromyography of rectus femoris, vastus medialis, vastus lateralis, biceps femoris, and semitendinosus. Main Outcome Measures: An incremental optical encoder was used to assess maximal and mean power and force during concentric and eccentric phases. The neuromuscular efficiency was calculated using the mean force and the electromyographic linear envelope. Results: Between-group differences were observed for the maximal and mean force (P range = .001–.005), power (P = .001), and neuromuscular efficiency (P range = .001–.03) with higher significant values for the higher acceleration group in both concentric and eccentric phases. Conclusion: Distinct acceleration profiles affect the neuromuscular efficiency, force, and power during concentric and eccentric phases of isoinertial squatting exercise. To ensure immediate higher levels of power and force output without depriving the neuromuscular system, acceleration profiles higher than 2.5 m/s2 are preferable. The acceleration profiles could be an alternative to evolve the isoinertial exercise.

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Kyung-eun Lee, Seung-min Baik, Chung-hwi Yi, Oh-yun Kwon, and Heon-seock Cynn

Context: Side bridge exercises strengthen the hip, trunk, and abdominal muscles and challenge the trunk muscles without the high lumbar compression associated with trunk extension or curls. Previous research using electromyography (EMG) reports that performance of the side bridge exercise highly activates the gluteus medius (Gmed). However, to the best of our knowledge, no previous research has investigated EMG amplitude in the hip and trunk muscles during side bridge exercise in subjects with Gmed weakness. Objective: The purpose of this study was to examine the EMG activity of the hip and trunk muscles during 3 variations of the side bridge exercise (side bridge, side bridge with knee flexion, and side bridge with knee flexion and hip abduction of the top leg) in subjects with Gmed weakness. Design: Repeated-measures experimental design. Setting: Research laboratory. Patients: Thirty subjects (15 females and 15 males) with Gmed weakness participated in this study. Intervention: Each subject performed 3 variations of the side bridge exercise in random order. Main Outcome Measures: Surface EMG was used to measure the muscle activities of the rectus abdominis, external oblique, longissimus thoracis, multifidus, Gmed, gluteus maximus, and tensor fasciae latae (TFL), and Gmed/TFL muscle activity ratio during 3 variations of the side bridge exercise. Results: There were significant differences in Gmed (F 2,56 = 110.054, P < .001), gluteus maximus (F 2,56 = 36.416, P < .001), and TFL (F 2,56 = 108.342, P < .001) muscles among the 3 side bridge exercises. There were significant differences in the Gmed/TFL muscle ratio (F 2,56 = 20.738, P < .001). Conclusion: Among 3 side bridge exercises, the side bridge with knee flexion may be effective for the individuals with Gmed weakness among 3 side bridge exercises to strengthen the gluteal muscles, considering the difficulty of the exercise and relative contribution of Gmed and TFL.

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Bruno Augusto Lima Coelho, Helena Larissa das Neves Rodrigues, Gabriel Peixoto Leão Almeida, and Sílvia Maria Amado João

Context: Restriction in ankle dorsiflexion range of motion (ROM) has been previously associated with excessive dynamic knee valgus. This, in turn, has been correlated with knee pain in women with patellofemoral pain. Objectives: To investigate the immediate effect of 3 ankle mobilization techniques on dorsiflexion ROM, dynamic knee valgus, knee pain, and patient perceptions of improvement in women with patellofemoral pain and ankle dorsiflexion restriction. Design: Randomized controlled trial with 3 arms. Setting: Biomechanics laboratory. Participants: A total of 117 women with patellofemoral pain who display ankle dorsiflexion restriction were divided into 3 groups: ankle mobilization with anterior tibia glide (n = 39), ankle mobilization with posterior tibia glide (n = 39), and ankle mobilization with anterior and posterior tibia glide (n = 39). Intervention(s): The participants received a single session of ankle mobilization with movement technique. Main Outcome Measures: Dorsiflexion ROM (weight-bearing lunge test), dynamic knee valgus (frontal plane projection angle), knee pain (numeric pain rating scale), and patient perceptions of improvement (global perceived effect scale). The outcome measures were collected at the baseline, immediate postintervention (immediate reassessment), and 48 hours postintervention (48 h reassessment). Results: There were no significant differences between the 3 treatment groups regarding dorsiflexion ROM and patient perceptions of improvement. Compared with mobilization with anterior and posterior tibia glide, mobilization with anterior tibia glide promoted greater increase in dynamic knee valgus (P = .02) and greater knee pain reduction (P = .02) at immediate reassessment. Also compared with mobilization with anterior and posterior tibia glide, mobilization with posterior tibia glide promoted greater knee pain reduction (P < .01) at immediate reassessment. Conclusion: In our sample, the direction of the tibia glide in ankle mobilization accounted for significant changes only in dynamic knee valgus and knee pain in the immediate reassessment.

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Arthur Alves Dos Santos, James Sorce, Alexandra Schonning, and Grant Bevill

This study evaluated the performance of 6 commercially available hard hat designs—differentiated by shell design, number of suspension points, and suspension tightening system—in regard to their ability to attenuate accelerations during vertical impacts to the head. Tests were conducted with impactor materials of steel, wood, and lead shot (resembling commonly seen materials in a construction site), weighing 1.8 and 3.6 kg and dropped from 1.83 m onto a Hybrid III head/neck assembly. All hard hats appreciably reduced head acceleration to the unprotected condition. However, neither the addition of extra suspension points nor variations in suspension tightening mechanism appreciably influenced performance. Therefore, these results indicate that additional features available in current hard hat designs do not improve protective capacity as related to head acceleration metrics.

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Pavlos Angelopoulos, Konstantinos Mylonas, Elias Tsepis, Evdokia Billis, Nikolaos Vaitsis, and Konstantinos Fousekis

Context: Instrument-assisted soft tissue mobilization (IASTM), tissue flossing, and kinesiology taping are increasingly popular treatments among athletes for improving functional performance, despite limited evidence for their efficacy. Objective: Previous research regarding the efficacy of soft tissues and neuromuscular techniques on improving functional capacity of shoulder joints in athletes has yielded conflicting results. We examined the immediate and short-term effects of IASTM, flossing, and kinesiology taping on the functional capacities of amateur athletes’ shoulders. Design: Randomized controlled study. Setting: Clinical assessment laboratory. Participants: Eighty amateur overhead athletes (mean [SD]: age = 23.03 [1.89]; weight = 78.36 [5.32]; height = 1.77 [.11]). Interventions: We randomly assigned participants to 4 research sub-groups in which they received the following treatments on their dominant shoulders: IASTM (n = 20), flossing (n = 20), both IASTM and flossing (n = 20), and kinesiology tape (n = 20). Nondominant shoulders served as controls. Main Outcome Measure: We evaluated participants—before, immediately after, and 45 minutes after the therapeutic interventions—with the following tests: internal and external shoulder rotation range of motion, isokinetic strength and total work, the functional throwing performance index, and the one-arm seated shot put throw performance. Results: All therapeutic interventions significantly improved the strength and functional performance of the dominant shoulder in comparison with the control (P < .005) immediately after and 45 minutes after the treatment. The IASTM led to significantly greater improvement in shoulder internal rotation than kinesiology taping immediately after (P = .049) and 45 minutes after the treatment (P = .049). We observed no significant differences between the other treatment interventions (P > .05). Conclusion: Findings from the current study support the use of novel soft tissue and neuromuscular techniques for the immediate and short-term improvement of the shoulder functional capacities in amateur overhead athletes.

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John J. Fraser, Rachel Koldenhoven, and Jay Hertel

Context: Tibial nerve impairment and reduced plantarflexion, hallux flexion, and lesser toe flexion strength have been observed in individuals with recent lateral ankle sprain (LAS) and chronic ankle instability (CAI). Diminished plantar intrinsic foot muscles (IFMs) size and contraction are a likely consequence. Objectives: To assess the effects of ankle injury on IFM size at rest and during contraction in young adults with and without LAS and CAI. Setting: Laboratory. Design: Cross-sectional. Patients: A total of 22 healthy (13 females; age = 19.6 [0.9], body mass index [BMI] = 22.5 [3.2]), 17 LAS (9 females; age =21.8 [4.1], BMI = 24.1 [3.7]), 21 Copers (13 females; age = 20.8 [2.9], BMI = 23.7 [2.9]), and 20 CAI (15 females; age = 20.9 [4.7], BMI = 25.1 [4.5]). Main Outcome Measures: Foot Posture Index (FPI), Foot Mobility Magnitude (FMM), and ultrasonographic cross-sectional area of the abductor hallucis, flexor digitorum brevis, quadratus plantae, and flexor hallucis brevis were assessed at rest, and during nonresisted and resisted contraction. Results: Multiple linear regression analyses assessing group, sex, BMI, FPI, and FMM on resting and contracted IFM size found sex (B = 0.45; P < .001), BMI (B = 0.05; P = .01), FPI (B = 0.07; P = .05), and FMM × FPI interaction (B = −0.04; P = .008) accounted for 19% of the variance (P = .002) in resting abductor hallucis measures. Sex (B = 0.42, P < .001) and BMI (B = 0.03, P = .02) explained 24% of resting flexor digitorum brevis measures (P < .001). Having a recent LAS (B = 0.06, P = .03) and FMM (B = 0.04, P = .02) predicted 11% of nonresisted quadratus plantae contraction measures (P = .04), with sex (P < .001) explaining 13% of resting quadratus plantae measures (B = 0.24, P = .02). Both sex (B = 0.35, P = .01) and FMM (B = 0.15, P = .03) predicted 16% of resting flexor hallucis brevis measures (P = .01). There were no other statistically significant findings. Conclusions: IFM resting ultrasound measures were primarily determined by sex, BMI, and foot phenotype and not injury status. Routine ultrasound imaging of the IFM following LAS and CAI cannot be recommended at this time but may be considered if neuromotor impairment is suspected.

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Sergio Jiménez-Rubio, José Luis Estévez Rodríguez, and Archit Navandar

Context: The high rates of adductor injuries and reinjuries in soccer have suggested that the current rehabilitation programs may be insufficient; therefore, there is a need to create prevention and reconditioning programs to prepare athletes for the specific demands of the sport. Objective: The aim of this study is to validate a rehab and reconditioning program (RRP) for adductor injuries through a panel of experts and determine the effectiveness of this program through its application in professional soccer. Design: A 20-item RRP was developed, which was validated by a panel of experts anonymously and then applied to 12 injured male professional soccer players. Setting: Soccer pitch and indoor gym. Participants: Eight rehabilitation fitness coaches (age = 33.25 [2.49] y) and 8 academic researchers (age = 38.50 [3.74] y) with PhDs in sports science and/or physiotherapy. The RRP was applied to 12 male professional players (age = 23.75 [4.97] y; height = 180.56 [8.41] cm; mass = 76.89 [3.43] kg) of the Spanish First and Second Division (La Liga). Interventions: The experts validated an indoor and on-field reconditioning program, which was based on strengthening the injured muscle and retraining conditional capacities with the aim of reducing the risk of reinjury. Main Outcome Measures: Aiken V for each item of the program and number of days taken by the players to return to full team training. Results: The experts evaluated all items of the program very highly as seen from Aiken V values between 0.77 and 0.94 (range: 0.61–0.98) for all drills, and the return to training was in 13.08 (±1.42) days. Conclusion: This RRP following an injury to the adductor longus was validated by injury experts, and initial results suggested that it could permit a faster return to team training.

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Sima Mohammad Amoli, Peyman Aghaie Ataabadi, Amir Letafatkar, Gary B. Wilkerson, and Misagh B. Mansouri

Anterior cruciate ligament (ACL) injury is prevalent during the single-leg jump landing in various sports. The effects of cognitive loading and how it affects risk of ACL injury are not well understood. The purpose of this study is to examine how landing kinetics change in the presence of cognitive loading during a volleyball block. Cognitive loading decreased activations in vastus lateralis and rectus femoris, and increased activation in biceps femoris and medial gastrocnemius muscles. During landing, the first and second peaks of ground reaction forces were 13% and 11% lower under cognitive loading, suggesting that cognitive loading alters landing biomechanics and muscle activations.

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Gina E. McAlear and Jennifer K. Popp

An 18-year-old female, Division I soccer player was diagnosed with complex regional pain syndrome approximately 2 weeks after tarsal tunnel release surgery. Postsurgically, the patient reported a significant increase in neuropathic pain, swelling, paresthesia, skin temperature asymmetry, and allodynia of the plantar and dorsal aspects of the foot, which were initially attributed to other causes. The intense pain and delayed diagnosis led to a decline in mental health and suicide ideation. Once diagnosed with complex regional pain syndrome, an epidural was placed at L5/S1 with a continuous flow of lidocaine, resulting in functional restoration. The patient’s diagnosis and recovery were based on the collaborative efforts of the surgeon, sports medicine physician, pain management specialist, and athletic trainer. She returned to soccer participation with minimal symptoms. This case is unique because the symptoms of complex regional pain syndrome were attributed to other causes, resulting in a delayed diagnosis and appropriate treatment. This delay resulted in the patient threatening self-harm.