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Brian Killinger, Jakob D. Lauver, Luke Donovan and John Goetschius

Context: Muscle dysfunction is common in patients with chronic ankle instability (CAI). Blood flow restriction (BFR) may enhance muscle responses during exercise and provide an opportunity to enhance muscle adaptations to ankle rehabilitation exercises; however, there is no evidence examining the effect of BFR on muscle function in CAI patients. Objective: Examine the effects of BFR on muscle activation and oxygen saturation during submaximal ankle eversion and dorsiflexion exercises in individuals with CAI. Design: Cross-over study design. Setting: Laboratory setting. Patients (or Other Participants): Nineteen young adults with a history of CAI. Interventions: Participants performed 4 sets (30, 15, 15, and 15) of eversion and dorsiflexion resistance exercises at 30% of maximum voluntary isometric contraction during 2 conditions, BFR and control. For BFR, a cuff was applied above the knee at 80% of blood flow occlusion. For control, the cuff was not inflated. Main Outcome Measures: Fibularis longus and tibialis anterior electromyography muscle activation, lower-leg muscle oxygen saturation, and ratings of perceived exertion were recorded during exercises. Results: Average grand mean muscle activation was 5.6% greater during eversion (P = .03) and 7.7% greater during dorsiflexion (P = .01) resistance exercises with BFR compared with control; however, the magnitudes of the effects of BFR were only clinically important during the dorsiflexion exercises. Lower-leg muscle oxygen saturation was 31% to 44% lower (P < .001) during BFR exercises. Ratings of perceived exertion were significantly higher during BFR exercises (P < .001). Conclusions: Greater muscle activation and hypoxia were present during submaximal resistance exercise with BFR in participants with CAI. Greater muscle activation and hypoxia during BFR exercises may be important acute responses mediating the training-related muscle adaptations that have been observed with BFR. The presence of these acute responses in CAI patients supports further research examining BFR as a potential ankle rehabilitation tool.

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Anis Rostami, Amir Letafatkar, Alli Gokeler and Mehdi Khaleghi Tazji

Context: Female volleyball players are more predisposed to anterior cruciate ligament injury in comparison with their male counterparts. Recent research on anterior cruciate ligament injury prevention strategies has shown the positive results of adopting the external focus (EF) of attention in sports. Objective: To determine the effect of 6-week EF instruction exercises on performance and kinetic factors associated with lower-extremity injury in landing after the volleyball blocks of female athletes. Design: Pretest and posttest control study. Setting: University research laboratory. Participants: Thirty-two female volleyball players (18–24 y old) from the same team randomly divided into experimental (n = 16) and control (n = 16) groups. Intervention: The experimental group performed a 6-week exercise program with EF instructions. The control group continued its regular volleyball team schedule. Main Outcome Measures: To assess function, single-leg triple hop test for distance was used. A force plate was used to evaluate kinetic variables including vertical ground reaction forces, the rate of loading, and dynamic postural stability index. All data were assessed at baseline and after the intervention. Results: There was a significant increase in single-leg triple hop test (P < .05) and in the first and second peak ground reaction force, rate of loadings, dynamic postural stability index (P < .05). Conclusion: According to the results of this study, anterior cruciate ligament injury prevention programs should incorporate EF instruction exercises to enhance the kinetics and to increase athletes’ functional performance.

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Banu Unver, Emin Ulas Erdem and Eda Akbas

Context: Pes planus is a prevalent chronic condition that causes foot pain, disability, and impaired plantar load distribution. Short-foot exercises are often recommended to strengthen intrinsic foot muscles and to prevent excessive decrease of medial longitudinal arch height. Objective: To investigate the effects of short-foot exercises on navicular drop, foot posture, pain, disability, and plantar pressures in pes planus. Design: Quasi-experimental study. Setting: Biomechanics laboratory. Participants: A total of 41 participants with pes planus were assigned to the short-foot exercises group (n = 21) or the control group (n = 20). Intervention: Both groups were informed about pes planus, usual foot care, and appropriate footwear. Short-foot exercises group performed the exercises daily for 6 weeks. Main Outcome Measures: Navicular drop, Foot Posture Index, foot pain, disability, and plantar pressures were assessed at the baseline and at the end of 6 weeks. Results: Navicular drop, Foot Posture Index, pain, and disability scores were significantly decreased; maximum plantar force of midfoot was significantly increased in short-foot exercises group over 6 weeks (P < .05). No significant differences were determined between the baseline and the sixth week outcomes in control group (P > .05). Conclusions: Six-week short-foot exercises provided a reduction in navicular drop, foot pronation, foot pain, and disability and increment in plantar force of medial midfoot in pes planus.

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Gemma V. Espí-López, Pilar Serra-Añó, David Cobo-Pascual, Manuel Zarzoso, Luis Suso-Martí, Ferran Cuenca-Martínez and Marta Inglés

Context: Knee injury prevention is a critical aspect in sport rehabilitation sciences, and taping is a widely used technique in this field. Nevertheless, the role and effectiveness of a long-term application of Kinesio Taping (KT) on knee function, disability, and injury prevention remain unclear. Objective: To determine the effect of KT, alone or in combination with balance exercises (BE), on dynamic and static knee balance and flexibility. Design: Randomized trial design. Setting: University of Valencia (Spain). Participants: Forty-eight male amateur soccer players. Intervention: Participants were assigned to 3 groups: Sham KT (sKT) + BE, KT + BE, and KT in isolation. The intervention period lasted 4 weeks. Three evaluations were performed: at baseline (pre), at 2 weeks (mid), and at 4 weeks posttreatment (post). Main outcome measures: Y Balance Test, unipedal stance test, the toe touch test, and the Knee Injury and Osteoarthritis Outcome Score. Results: Both sKT + BE and KT + BE groups achieved significant pre–post improvements in SEBT, unipedal stance test, and toe touch test. The KT group only showed significant intragroup differences in the left and right unipedal stance test variable (P < .05, d = 0.76, d = 0.62, respectively). The sham KT group obtained the strongest results in all physical variables. Regarding the Knee Injury and Osteoarthritis Outcome Score, pre–post significant changes were found in the sham group (P < .05, d = 0.28). Conclusions: Both sham and real KT in combination with BE achieved significant improvements on all physical variables, and these differences were significantly greater compared with those found in the KT in the isolation group, suggesting that benefits in knee function are due to the BE. Level of Evidence: Therapy level 1b.

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Rumit S. Kakar, Hilary B. Greenberger and Patrick O. McKeon

Context: Anterior knee pain also known as patellofemoral pain syndrome is a frequently encountered musculoskeletal disorder that worsens with activity. The multifactorial etiology of patellofemoral pain syndrome alters lower-extremity mechanics, increasing patellofemoral joint stresses during weight-bearing tasks. Kinesio and McConnell tapings are often incorporated into the treatment, but their efficacy is still unclear. Objective: To test the efficacy of Kinesio taping, McConnell taping, and sham taping in improving knee mechanics and reducing pain during activity. Design: Cross-sectional design. Setting: Clinical biomechanics laboratory. Participants: Ten participants (age: 20.3 [1.5] y, height: 169.9 [10.4] cm, and mass: 70.17 [13.1] kg) with anterior knee pain and no history of trauma. Intervention: Three trials each of squat, drop jump, and step-down tasks with 3 taping conditions in a counterbalanced order. Main Outcome Measures: Two-dimensional motion capture data of lower-extremities in frontal and sagittal planes were recorded and analyzed using 3 iPads and Spark Motion® application. Pooled effect sizes (Hedges’ g), 95% confidence intervals, and repeated-measures analysis of variance (P < .05) compared baseline and taping conditions during exercises for pain Visual Analog Scale and knee flexion in all exercises, hip abduction during step-down and drop jump, frontal plane projection during step-downs, and knee translation in sagittal plane during squats. Results: Significant reductions in Visual Analog Scale were recorded during squats between tapes (F 2.505,12.867 = 3.407, P = .04, Hedges’ g = −0.70). Pairwise comparison showed a decrease in Visual Analog Scale for sham taping (mean difference = 1.14 cm, P = .01) and Kinesio taping (mean difference = 1.54 cm, P = .02) compared with baseline during squats. Conclusions: A variety of taping methods can potentially reduce perceived pain in individuals with patellofemoral pain syndrome, allowing clinicians to perform rehabilitation exercises. Sensory effects associated with short-term taping may be sufficient enough to modify knee pain acutely by afferent input blocking nocioceptive pain before the participants could adapt. Most interestingly, the sham taping technique demonstrated promise for enhancing functional outcomes, depending on the length of the tape and area covered.

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Luke Wilkins, Jen Sweeney, Zoella Zaborski, Carl Nelson, Simon Tweddle, Eldre Beukes and Peter Allen

The purpose of the present study was to address perceptions towards Cognitive Behavioral Therapy (CBT) in soccer. Twenty-four male, elite academy soccer players (M age = 20.04) completed a custom-made questionnaire which included education on CBT. The results found that: i) initially, only 8% of players had heard of CBT whilst only 4% of players knew what CBT was, ii) players strongly agreed that CBT should be offered to all players, iii) not knowing how/where to seek help was identified as the main barrier to CBT, iv) players indicated a preference for one-to-one and face-to-face CBT, as opposed to small-group or online-CBT, and v) players perceived they would receive most support from family/friends, and least support from teammates, if they were to undertake CBT. These findings demonstrate that whilst initial awareness and knowledge of CBT is low, general perceptions towards CBT are positive once athletes are educated on the area.

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Bradley Donohue, Marina Galante, Julia Maietta, Bern Lee, Nina Paul, Joanne E. Perry, Arianna Corey and Daniel N. Allen

The conspicuous absence of validated screening measures specific to mental health symptomology in collegiate athletes has negatively affected clinical practice in this population. Therefore, this study was performed to develop a sport specific measure to optimally identify collegiate athletes who are particularly likely to benefit from mental health programming. Participants were 289 collegiate-athletes who were assessed for mental health symptomology using the Global Severity Index of Symptom Checklist-90-Revised (GSI), factors that interfere with sport performance using the Problems in Sport Competition Scale (PSCS) and Problems in Sport Training Scale (PSTS), and motivation to pursue professional counseling using the Desire to Pursue Sport Psychology Scale (DSPS). As hypothesized, a hierarchical multiple regression analysis indicated that PSCS, PSTS and DSPS scores significantly predicted GSI scores, controlling gender and sport status (NCAA, club, intramural). Receiver operating characteristic (ROC) analysis indicated that high-risk athletes (GSI T-scores ≥ 60) could be correctly classified by PSTS and PSCS scores. Results suggest the PSCS and PSTS may assist identification of collegiate athletes who are especially appropriate for mental health programs. These scales additionally identify factors directly relevant to athletes’ sport performance.

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Zachary Y. Kerr, Susan W. Yeargin, Yuri Hosokawa, Rebecca M. Hirschhorn, Lauren A. Pierpoint and Douglas J. Casa

Context: Recent data on exertional heat illness (EHI) in high school sports are limited yet warranted to identify specific settings with the highest risk of EHI. Objective: To describe the epidemiology of EHI in high school sports during the 2012/2013–2016/2017 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from athletic trainers working in high school sports in the United States. Patients or Other Participants: High school athletes during the 2012/2013–2016/2017 academic years. Intervention: High School Reporting Information Online surveillance system data from the 2012/2013–2016/2017 academic years were analyzed. Main Outcome Measures: EHI counts, rates per 10,000 athlete exposures (AEs), and distributions were examined by sport, event type, and US census region. EHI management strategies provided by athletic trainers were analyzed. Injury rate ratios with 95% confidence intervals (CIs) compared EHI rates. Results: Overall, 300 EHIs were reported for an overall rate of 0.13/10,000 AE (95% CI, 0.11 to 0.14). Of these, 44.3% occurred in American football preseason practices; 20.7% occurred in American football preseason practices with a registered air temperature ≥90°F and ≥1 hour into practice. The EHI rate was higher in American football than all other sports (0.52 vs 0.04/10,000 AE; injury rate ratio = 11.87; 95% CI, 9.22 to 15.27). However, girls’ cross-country had the highest competition EHI rate (1.18/10,000 AE). The EHI rate was higher in the South US census region than all other US census regions (0.23 vs 0.08/10,000 AE; injury rate ratio = 2.96; 95% CI, 2.35 to 3.74). Common EHI management strategies included having medical staff on-site at the onset of EHI (92.7%), removing athlete from play (85.0%), and giving athlete fluids via the mouth (77.7%). Conclusions: American football continues to have the highest overall EHI rate although the high competition EHI rate in girls’ cross-country merits additional examination. Regional differences in EHI incidence, coupled with sport-specific variations in management, may highlight the need for region- and sport-specific EHI prevention guidelines.

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Armand A. Buzzelli and Jason A. Draper

Pickleball, a paddle sport that combines aspects of tennis, badminton, and table tennis, is one of the fastest growing sports in America. The sport is especially popular with older adults as it provides a means for both competition and exercise. Limited research is available on the motivation and perceived benefits of participants in this unique and growing community. A total of 3,012 participants completed a survey instrument that included items from the Sport Motivation Scale, the Task and Ego Orientation in Sport Questionnaire, and the Quality and Importance of Recreational Services. Participants reported being more task oriented than ego oriented, suggesting that pickleball may effectively satisfy the need for persons to be engaged in physical activities that allow for the ongoing development of personal mastery. This finding is supported by respondents noting that their primary motivation to participate in pickleball involved mastering difficult training techniques. However, participants cited competition as the top perceived benefit to their participation. This result supports two possible conclusions that motivation and benefit are different and potentially disconnected constructs or that the benefit of competition among this sample of older persons is understood through the lens of personal mastery, whereby the demonstration of that mastery is only possible through competition.

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Nicole T. Gabana, Aaron D’Addario, Matteo Luzzeri, Stinne Soendergaard and Y. Joel Wong

Salient aspects of an athlete’s identity hold implications for how sport psychology practitioners conceptualize and intervene on both the mental health and performance realms of the athlete person. Given that spirituality, religiosity, and gratitude have been associated in previous literature, the current study examined whether athletes differed in dispositional gratitude based on their spiritual and religious identification. Results indicated that among 331 NCAA Division I-III athletes, those who identified as both spiritual and religious scored significantly higher in dispositional gratitude than self-identified spiritual/non-religious and non-spiritual/non-religious athletes. Non-spiritual/non-religious and spiritual/non-religious athletes did not significantly differ in levels of gratitude. Findings and limitations of the current study warrant further investigation on this topic, and recommendations for future research and practice are provided.