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Jay R. Ebert, Kate E. Webster, Peter K. Edwards, Brendan K. Joss, Peter D’Alessandro, Greg Janes and Peter Annear

Context: The importance of rehabilitation and evaluation prior to return to sport (RTS) in patients undergoing anterior cruciate ligament reconstruction has been reported. Objective: This study sought to investigate current perspectives of Australian orthopedic surgeons on rehabilitation and RTS evaluation. Design: Survey. Participants: Members of the Australian Knee Society. Main Outcome Measures: A 14-question survey was disseminated to Australian Knee Society members (orthopedic surgeons) to investigate (1) preferred graft choice, (2) estimated retear rate, (3) importance of preoperative and postoperative rehabilitation, and (4) preferred timing of RTS and evaluation prior to RTS discharge. Results: Of all 85 Australian Knee Society members contacted, 86% (n = 73) responded. Overall, 66 respondents (90.4%) preferentially used hamstring tendon autografts. All surgeons estimated their retear rate to be ≤15%, with 31 (42.5%) <5%. Twenty-eight surgeons (38.4%) reported no benefit in preoperative rehabilitation. The majority of surgeons (82.2%–94.5%) reported that postoperative rehabilitation was important within various periods throughout the postoperative timeline. Most surgeons did not permit RTS until ≥9 months (n = 56, 76.7%), with 17 (23.3%) allowing RTS between 6 and 9 months. The most highly reported considerations for RTS clearance were time (90.4%), functional capacity (90.4%), and strength (78.1%). Most commonly, knee strength and/or function was assessed via referral to a preferred rehabilitation specialist (50.7%) or with the surgeon at their practice (11.0%). Conclusions: This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation. This is despite the current evidence demonstrating the benefit of preoperative and postoperative rehabilitation, as well as the emerging potential of RTS assessments consisting of strength and functional measures to reduce reinjury rates.

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Isabel Mayer, Matthias W. Hoppe, Jürgen Freiwald, Rafael Heiss, Martin Engelhardt, Casper Grim, Christoph Lutter, Moritz Huettel, Raimund Forst and Thilo Hotfiel

Context: Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood. Objective: To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience. Design: Case series. Setting: Laboratory environment. Participants: The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA). Intervention: The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial. Main Outcome Measures: Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band). Results: In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05). Conclusions: This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes’ experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.

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Brigid M. Lynch, Andrea Ramirez Varela and Terry Boyle

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Sarah C. Moudy, Neale A. Tillin, Amy R. Sibley and Siobhán Strike

Individuals with unilateral transtibial amputations experience greater work demand and loading on the intact limb compared with the prosthetic limb, placing this limb at a greater risk of knee joint degenerative conditions. It is possible that increased loading on the intact side may occur due to strength deficits and joint absorption mechanics. This study investigated the intact limb mechanics utilized to attenuate load, independent of prosthetic limb contributions and requirements for forward progression, which could provide an indication of deficiencies in the intact limb. Amputee and healthy control participants completed 3 unilateral drop landings from a 30-cm drop height. Joint angles at touchdown; range of motion; coupling angles; peak powers; and negative work of the ankle, knee, and hip were extracted together with isometric quadriceps strength measures. No significant differences were found in the load or movement mechanics (P ≥ .31, g ≤ 0.42), despite deficits in isometric maximum (20%) and explosive (25%) strength (P ≤ .13, g ≥ 0.61) in the intact limb. These results demonstrate that, when the influence from the prosthetic limb and task demand are absent, and despite deficits in strength, the intact limb adopts joint mechanics similar to able-bodied controls to attenuate limb loading.

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Andrea Nicolò, Marco Montini, Michele Girardi, Francesco Felici, Ilenia Bazzucchi and Massimo Sacchetti

Purpose: Variables currently used in soccer training monitoring fail to represent the physiological demand of the player during movements like accelerations, decelerations, and directional changes performed at high intensity. We tested the hypothesis that respiratory frequency (f R) is a marker of physical effort during soccer-related high-intensity exercise. Methods: A total of 12 male soccer players performed a preliminary intermittent incremental test and 2 shuttle-run high-intensity interval training (HIIT) protocols, in separate visits. The 2 HIIT protocols consisted of 12 repetitions over 9 minutes and differed in the work-to-recovery ratio (15:30 vs 30:15 s). Work rate was self-paced by participants to achieve the longest possible total distance in each HIIT protocol. Results: Work-phase average metabolic power was higher (P < .001) in the 15:30-second protocol (31.7 [3.0] W·kg−1) compared with the 30:15-second protocol (22.8 [2.0] W·kg−1). Unlike heart rate and oxygen uptake, f R showed a fast response to the work–recovery alternation during both HIIT protocols, resembling changes in metabolic power even at supramaximal intensities. Large correlations (P < .001) were observed between f R and rating of perceived exertion during both 15:30-second (r = .87) and 30:15-second protocols (r = .85). Conclusions: Our findings suggest that f R is a good marker of physical effort during shuttle-run HIIT in soccer players. These findings have implications for monitoring training in soccer and other team sports.

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Yubing Wang and Ang Chen

Purpose: This study aimed to determine the extent to which a concept-based physical education curriculum, specifically the Science of Healthful Living (SHL) curriculum, influenced middle school students’ knowledge, motivation for physical education (PE) and physical activity (PA), and out-of-school PA. Methods: A static group comparison design was adopted to analyze the differences on fitness knowledge, autonomous motivation for PE and PA, and out-of-school PA between eighth-grade students who studied the SHL curriculum (the experimental condition, n = 168) and their peers who studied a multiactivity PE (the control condition, n = 226) 1 year earlier. Results: The students who studied the SHL curriculum demonstrated significantly higher levels of knowledge (p < .05, Cohen d = 0.81), autonomous motivation toward PA (p < .05, Cohen d = 0.20), and out-of-school PA (p < .05, Mann–Whitney U effect size = 0.01) than students who had experienced the multiactivity PE. The students in both conditions were equally motivated in their respective PE courses. Conclusion: The SHL curriculum is effective in promoting students’ PA behavior outside of the school.

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Bassam A. Nabil, Mariam A. Ameer, Azza M. Abdelmohsen, Abeer F. Hanafy, Ahmed S. Yamani, Naglaa M. Elhafez and Salam M. Elhafez

Context: Upper limb activities require a repetitive movement of the shoulder external rotator and abductor muscles. The malfunction of the proximal part of the upper limb kinetic chain tends to change the mechanics of the distal part and increase the risk of injuries. Objectives: To compare the normalized eccentric peak torque (NEPT) of the shoulder external rotator and abductor muscles among healthy athletes and those with tennis elbow and golfer’s elbow. Design: An experimental cross-sectional study. Setting: Isokinetic laboratory, Faculty of Physical Therapy, Cairo University. Participants: A total of 30 male athletes participated voluntarily in this study. Intervention: Participants were distributed into 3 groups: healthy group, tennis elbow group, and golfer’s elbow group. Main Outcome Measures: NEPT of shoulder abductors and external rotators. The Biodex Isokinetic Dynamometer was used to measure the variables of interest. Results: There was a significant increase in the NEPT of shoulder abductors and external rotators in healthy control group compared with both tennis elbow and golfer’s elbow groups at an angular velocity of 60°/s (P < .05). Moreover, there was a significant increase in the NEPT of shoulder external rotators and abductors at an angular velocity of 120°/s in healthy control group compared with tennis elbow group and in golfer’s elbow group compared with tennis elbow group (P < .05). Conclusion: Tennis elbow and golfer’s elbow are associated with decreased NEPT of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain.

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Kim C. Graber, Amelia Mays Woods, Chad M. Killian, K. Andrew R. Richards and Jesse L. Rhoades

Purpose: The landscape of physical education has shifted in the 30 years since Metzler and Freedman’s seminal study examining the demographics of physical education teacher education faculty. Changes in the structure of physical education and academia justify an updated investigation, with particular emphasis on the gender and institutional affiliation of faculty. Methods: An expanded and validated version of Metzler and Freedman’s survey was e-mailed to 908 physical education teacher education faculty from 505 U.S. institutions. A response rate of 46.21% was achieved. The data were analyzed using descriptive and inferential statistics to examine differences based on gender and institutional affiliation. Results: Gender salary disparities have decreased, whereas teaching experience and qualifications of faculty have increased. Corresponding increases in research productivity were notably evident. Discussion/Conclusion: Faculty members remain predominately European American, publication output has increased, more institutions are hiring nontenure-track faculty, and perceptions of support for physical education are lower than in 1985.

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Daniel Boullosa

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Ken Lodewyk and Lauren McNamara

Purpose: This study assessed students’ levels and associations between recess enjoyment, positive affect, environmental factors, and activity preferences overall and as a function of gender and developmental level. Methods: An online survey was used to gather data from 464 students in Grades 4–8 from nine elementary schools in southwestern Ontario, Canada. Results: When the variance explained by gender and developmental level was controlled for in this study, both recess environment and activity preferences accounted for a significant portion of the variability related to affect and enjoyment of recess. Having equipment and space and preference for moderate-to-vigorous physical activity, organizing and playing games, and free time predicted both affect and enjoyment. Conclusion: These and other findings enable educators to progress in understanding how they might adjust approaches to recess to facilitate more enjoyment and positive affect in elementary school students especially by gender and developmental level.