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Lucinda E. Bouillon, Michael Hofener, Andrew O’Donnel, Amanda Milligan and Craig Obrock

Context: Unstable devices in various forms are used as therapeutic adjuncts for prevention or following an injury. A slip-over-the-shoe design with inflatable domes (STEPRIGHT® Stability Trainer) was developed to improve balance. It is unknown how this unstable device affects muscle activity during a closed-chain exercise such as the forward lunge. Objective: To compare muscle activity across 3 surfaces (STEPRIGHT®, Both Sides Up [BOSU®] Balance Trainer, and firm) during a forward lunge. Design: Within-subject, repeated measures. Setting: University physical therapy research laboratory. Participants: A total of 20 healthy, recreationally active subjects (23.4 [1.47] y, 172.7 [14.7] cm, 71.6 [16.8] kg). Intervention: Each subject performed 1 set of 10 repetitions of forward lunge exercise in random order with STEPRIGHT®, BOSU®, and firm surface. Main Outcome Measures: Surface electromyography data, normalized to maximum voluntary isometric contractions (%MVIC), was used to assess muscle activity on rectus femoris, vastus medialis oblique (VMO), biceps femoris, lateral gastrocnemius, fibularis longus, and tibialis anterior. Results: The repeated-measures analysis of variance determined that there was a significant effect for surface type. During the descent of the lunge, the STEPRIGHT® elicited higher rectus femoris (33% [27%] MVIC) compared with BOSU® (22% [14%] MVIC) and VMO (44% [15%] MVIC) on STEPRIGHT® compared with firm (38% [11%] MVIC) (P < .05). During the ascent of the lunge, the rectus femoris (38% [27%] MVIC) using STEPRIGHT® was higher than BOSU® (24% [16%] MVIC), and STEPRIGHT® elicited higher VMO (65% [20%] MVIC) versus BOSU® (56% [19%] MVIC) (P ≤ .01). The STEPRIGHT® for fibularis longus was higher (descent: 51% [20%] MVIC, ascent: 52% [22%] MVIC) than BOSU® (descent: 36% [15%] MVIC, ascent: 33% [16%] MVIC) or firm (descent: 33% [12%] MVIC, ascent: 35% [15%] MVIC) (P < .001). Conclusions: Clinicians may choose to use the STEPRIGHT® for strengthening VMO and fibularis longus muscles, as these were over 41% MVIC or any of the 3 surfaces for endurance training (<25% MVIC) for biceps femoris muscle. This information may be helpful in exercise dosage for forward lunges when using STEPRIGHT®, BOSU®, or a firm surface.

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Matthew Rivera, Lindsey Eberman, Kenneth Games and Cameron J. Powden

Context: The pectoralis minor (PM) is an important postural muscle that may benefit from myofascial techniques, such as Graston Technique® (GT) and self-myofascial release (SMR). Objective: To examine the effects of GT and SMR on PM length, glenohumeral total arc of motion (TAM), and skin temperature. Design: Cohort. Setting: Laboratory. Participants: Twenty-six healthy participants (19 females and 7 males; age = 20.9 [2.24] y, height = 170.52 [8.66] cm, and weight = 72.45 [12.32] kg) with PM length restriction participated. Interventions: Participants were randomized to the intervention groups (GT = 12 and SMR = 14). GT and SMR interventions were both applied for a total of 5 minutes during each of the 3 treatment sessions. Main Outcome Measures: PM length, TAM, and skin temperature were collected before and after each intervention session (Pre1, Post1, Pre2, Post2, Pre3, and Post3) and at 1-week follow-up (follow-up). Separate intervention by time analyses of variance examined differences for each outcomes measure. Bonferroni post hoc analyses were completed when indicated. Significance was set a priori at P ≤ .05. Results: No significant intervention by time interactions were identified for PM length, TAM, or temperature (P > .05). No significant intervention main effects were identified for PM length (P > .05), TAM (P > .05), or temperature (P > .05) between the GT or SMR technique groups. Overall, time main effects were found for PM length (P = .02) and temperature (P < .001). Post hoc analysis showed a significant increase in PM length for both intervention groups at follow-up (P = .03) compared with Post2. Furthermore, there were significant increases in temperature at Post1 (P < .001), Post2 (P = .01), and Post3 (P < .001) compared with Pre1; Post2 was increased compared with Pre2 (P = .003), Pre3 (P < .001), and follow-up (P = .01); Post3 increased compared with Pre3 (P = .01) and follow-up (P = .01). Conclusion: Serial application of GT and SMR to the PM did not result in increases in PM length or TAM. Regardless of intervention, skin temperature increased following each intervention.

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Josep C. Benítez-Martínez, Pablo Martínez-Ramírez, Fermín Valera-Garrido, Jose Casaña-Granell and Francesc Medina-Mirapeix

Context: The prevalence and negative consequences of the symptoms surrounding patellar tendinopathy constitute an important problem for sports medicine professionals. The identification of potential pain mediators is, therefore, of major interest to improve both the prevention and management of this injury. Objective: To compare the pain experienced by elite male adult basketball players and patterns of patellar tendon abnormalities. Also, to identify whether structural and vascular sonographic abnormalities (focal area of hypoechogenicity, thickening, and neovascularization [NV]) are equal in determining pain perceptions. Design: An observational study with professional basketball teams (ACB—Spanish league). Participants: A total of 73 male basketball players (mean age 26.8 y). Main Outcome Measures: Patellar tendon ultrasonography images. Pain scores were compared between the identified patterns. Multiple regression analysis was used to examine the relative importance of abnormalities. Results: Of the 146 tendons, 91 had some degree of sonographic abnormality. Three main patterns were identified: I (1 structural abnormality without NV), II (2 structural abnormalities without NV), and III (2 structural abnormalities and NV). A total of 31 tendons (21.2%) exhibited pattern I, 46 (31.5%) presented pattern II, and 13 tendons (8.9%) exhibited pattern III. The mean visual analog scale and the Victorian Institute of Sport assessment questionnaire—patellar tendon (VISA-P) scores for pattern III were significantly different (P < .05) compared with patterns I and II; however, the pain pressure threshold (PPT) scores were not. NV was significantly associated with worsened scores for all pain measures; however, the focal area of hypoechogenicity was only associated with PPT scores. Conclusion: Patterns of sonographic abnormalities, including NV, demonstrated greater pain. Although NV determined scores for the visual analog scale, VISA-P, and PPT, the presence of focal area of hypoechogenicity on its own is a determining factor for the PPT. This study suggests that the combination of 2 or more sonographic abnormalities may help explain pain variations among basketball players.

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Mastour S. Alshaharani, Everett B. Lohman, Khaled Bahjri, Travis Harp, Mansoor Alameri, Hatem Jaber and Noha S. Daher

Context: Protonics knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking. Objective: To compare the effect of Protonics knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome. Design: Randomized controlled trial. Setting: Loma Linda University. Participants: There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m2 participated in the study. Intervention: Subjects were randomized to 1 of 2 treatment groups, the Protonics knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks. Main Outcome Measures: Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test. Results: Both groups showed significant improvement in the outcome measures. However, the Protonics knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction. Conclusions: Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome.

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Takuma Hoshiba, Hiroki Nakata, Yasuaki Saho, Kazuyuki Kanosue and Toru Fukubayashi

Context: Deficits in knee position sense following reconstruction of the anterior cruciate ligament (ACL) can delay an athlete’s return to sport participation and increase the risk of reinjury. Deficits in position sense postreconstruction have been evaluated using either a position-reproducing or position-matching task. Objective: The aim of our study was to combine both to determine which assessment would be more effective to identify deficits in knee position sense. Design: Longitudinal laboratory-based study. Participants: Eleven athletes (6 men and 5 women; mean age, 20.5 [1.2] y), who had undergone ACL reconstruction with an ipsilateral hamstring autograft, and 12 age-matched controls. Interventions: Position sense was evaluated at 6 and 12 months postreconstruction and once for the control group. In addition, peak isokinetic knee extension and flexion strength, at 60°/s and 180°/s, was assessed for the ACL reconstruction group to evaluate possible influences of muscle strength on knee joint position sense. Main Outcome Measures: The variables include the angular differences between the reference limb and indicator limb, and peak torque values of isokinetic knee extension and flexion. Results: Significant matching differences were identified at 6 months postsurgery on the position-matching task, but not at 12 months postsurgery. No significant between-group and within-subject differences were identified on the position-reproducing task. No significant matching errors were identified for the control group. There was no correlation between errors in position sense and maximum isokinetic strength. Conclusion: The position-matching task is more sensitive than the position-reproducing task to identify deficits in knee position sense over the first year following ACL reconstruction surgery.

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Insook Kim and Bomna Ko

Purpose: This study examined how content knowledge (CK) varies between teachers with different levels of content expertise in teaching volleyball. In addition, it investigated changes to the content-experienced (C-Exd) teachers’ enacted pedagogical content knowledge (PCK) and their students’ performances after developing CK, compared with those of the content-expert (C-Ext) teachers. Method: Two C-Exd and two C-Ext teachers and their 72 students participated in this study. A well-designed CK workshop was implemented for the two C-Exd teachers’ CK improvement. Differences in the teachers’ CK, enacted PCK, and their students’ performance measures were compared. Results: The results of this study indicated that the C-Ext teachers possessed stronger CK than the C-Exd teachers and that the C-Exd teachers improved their enacted PCK and the students’ motor performance after the CK workshop without showing statistically significant differences from those of the C-Ext teachers. Conclusion: The study presents ways to promote teacher effectiveness with supportive evidence-based practices.

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Theresa L. Miyashita and Paul A. Ullucci

Context: Managing a concussion injury should involve the incorporation of a multifaceted approach, including a vision assessment. The frontoparietal circuits and subcortical nuclei are susceptible to trauma from a concussion injury, leading to dysfunction of the vestibulo-ocular system. Research investigating the effect of cumulative subconcussive impacts on neurological function is still in its infancy, but repetitive head impacts may result in vestibular system dysfunction. This dysfunction could create visual deficits, predisposing the individual to further head trauma. Objective: The purpose of this study was to investigate the cumulative effect of subconcussive impacts on minimum perception time, static visual acuity, gaze stability, and dynamic visual acuity scores. Design: Prospective cohort. Setting: Division I university. Patients: Thirty-three Division I men’s lacrosse players (age = 19.52 [1.20] y). Intervention: Competitive lacrosse season. Main Outcome Measures: At the beginning and end of the season, the players completed a vestibulo-ocular reflex assessment, using the InVision system by Neurocom® to assess perception, static acuity, gaze stability, and dynamic visual acuity. Score differentials were correlated with the head impact exposure data collected via instrumented helmets. Results: A significant correlation was found between change in perception scores and total number of head impacts (r = .54), and between changes in dynamic visual acuity loss scores on the rightside and maximum rotational acceleration (r = .36). No statistical differences were found between preseason and postseason vestibulo-ocular reflex variables. Conclusions: Cumulative subconcussive impacts may negatively affect vestibulo-ocular reflex scores, resulting in decreased visual performance. This decrease in vestibulo-ocular function may place the athlete at risk of sustaining additional head impacts or other injuries.

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Ashley A. Hansen, Joanne E. Perry, John W. Lace, Zachary C. Merz, Taylor L. Montgomery and Michael J. Ross

Evidence for the mechanisms of change by which sport psychology interventions enhance performance is limited and treatment monitoring and outcomes measures would assist in establishing evidence-based practices. The present paper fills a gap in sport psychology literature by demonstrating the development and validation of a new measure (Sport Psychology Outcomes and Research Tool; SPORT). Study 1 described test construction and pilot item selection with 73 collegiate student-athletes. Twenty-three pilot items contributed unique variance while maintaining the original constructs and were selected from 80 initial items. In Study 2, exploratory and confirmatory factor analyses were conducted with collegiate student-athletes (n = 220), revealing a 17-item, four-factor model measuring Athlete Wellbeing, Self-Regulation, Performance Satisfaction, and Sport-Related Distress. Concurrent validity was supported through correlational analyses. Overall, results supported the SPORT as a new transtheoretical tool for monitoring effectiveness and outcomes of sport psychology interventions.

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Brian J. Foster and Graig M. Chow

Well-being research conducted in competitive athletics has been marred by the lack of a context-specific measurement instrument. The purpose of this study was to adapt the Mental Health Continuum – Short Form (MHC-SF) to create a sport-specific well-being instrument, the Sport Mental Health Continuum—Short Form (Sport MHC-SF), and test its initial psychometric properties. Participants were 287 collegiate athletes from a variety of sports. Confirmatory factor analysis (CFA) determined a three-factor structure of sport well-being, consisting of subjective, psychological, and social factors, as the model of best fit. Internal consistency reliabilities of the subscales exceeded .88. Moderate positive correlations were found between Sport MHC-SF subscales and quality of life indices, notably physical and emotional quality of life, demonstrating convergent validity. The Sport MHC-SF will facilitate empirical research by providing a more accurate and comprehensive measurement of well-being for an athletic population.

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Jessica Ross and Peter D. MacIntyre

Flow is a desirable state of consciousness and absorption in an optimally challenging activity. Prior research has investigated individual differences in flow. The present study investigates flow by contrasting physical versus mental activities, using a mixed-methods, sequential explanatory design. The sample from the quantitative phase included 205 undergraduate university students assessed on measures of personality, difficulties in emotion regulation, and flow. The big-five traits intellect and conscientiousness, as well as the emotion regulation subscale “lack of emotional clarity” predicted flow during mental activities, but unexpectedly no variables significantly predicted physical flow activities. The second phase used semi-structured interviews with 10 participants. Analyses of the interviews helped further explain the statistical findings, revealing four main themes: role of stress, source of guilt, presence of others, and satisfaction and fulfillment. We conclude that flow is especially relevant in physical activities which have advantages over mental activities in opportunities to experience flow.