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Kevin Laudner and Kyle Thorson

Context: Tightness of the pectoralis minor is a common characteristic that has been associated with aberrant posture and shoulder pathology. Determining conservative treatment techniques for maintaining and lengthening this muscle is critical. Although some gross stretching techniques have been proven effective, there are currently no empirical data regarding the effectiveness of self-myofascial release for treating tightness of this muscle. Objective: To determine the acute effectiveness of a self-myofascial release with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. Design: Randomized controlled trial. Setting: Orthopedic rehabilitation clinic. Participants: A total of 21 physically active, college-aged individuals without shoulder pain volunteered to participate in this study. Main Outcome Measures: Glenohumeral internal rotation, external rotation, and flexion range of motion (ROM), pectoralis minor length, and forward scapular posture were measured in all participants. The intervention group received one application of a self-soft-tissue mobilization of the pectoralis minor with movement. The placebo group completed the same motions as the intervention group, but with minimal pressure applied to the xiphoid process. Separate analyses of covariance were used to determine differences between groups (P < .05). Results: Separate analyses of covariance showed that the self-mobilization group had significantly more flexion ROM, pectoralis minor length, and less forward scapular posture posttest than the placebo group. However, the difference in forward scapular posture may not be clinically significant. No differences were found between groups for external or internal rotation ROM. Conclusions: The results of this study indicate that an acute self-myofascial release with movement is effective for improving glenohumeral flexion ROM and pectoralis minor length, and may assist with forward scapular posture. Clinicians should consider this self-mobilization in the prevention and rehabilitation of pathologies associated with shortness of the pectoralis minor.

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Kenneth Färnqvist, Stephen Pearson and Peter Malliaras

Context: Exercise is seen as the most evidence-based treatment for managing tendinopathy and although the type of exercise used to manage tendinopathy may induce adaptation in healthy tendons, it is not clear whether these adaptations occur in tendinopathy and if so whether they are associated with improved clinical outcomes. Objective: The aim of the study was to synthesize available evidence for adaptation of the Achilles tendon to eccentric exercise and the relationship between adaptation (change in tendon thickness) and clinical outcomes among people with Achilles tendinopathy. Evidence Acquisition: The search was performed in September 2018 in several databases. Studies investigating the response (clinical outcome and imaging on ultrasound/magnetic resonance imaging) of pathological tendons (tendinopathy, tendinosis, and partial rupture) to at least 12 weeks of eccentric exercise were included. Multiple studies that investigated the same interventions and outcome were pooled and presented in effect size estimates, mean difference, and 95% confidence intervals if measurement scales were the same, or standard mean difference and 95% confidence intervals if measurements scales were different. Where data could not be pooled the studies were qualitatively synthesized based on van Tulder et al. Evidence Synthesis: Eight studies met the inclusion and exclusion criteria and were included in the review. There was strong evidence that Achilles tendon thickness does not decrease in parallel with improved clinical outcomes. Conclusions: Whether a longer time to follow-up is more important than the intervention (ie, just the time per se) for a change in tendon thickness remains unknown. Future studies should investigate whether exercise (or other treatments) can be tailored to optimize tendon adaptation and function, and whether this relates to clinical outcomes.

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Deepika Singla and M. Ejaz Hussain

Context: Neuromuscular adaptations following exercise training are believed to enhance sports performance. While abundant research is available on adaptations of the lower body to plyometric training, little is known about adaptations of the upper body to plyometric training. Objective: To examine the effect of plyometric training on neuromuscular adaptations in cricket players of different age groups. Design: Randomized parallel group active-controlled trial. Setting: Research laboratory, school cricket ground, and sports complex field. Participants: Fifty-nine cricket players were randomly assigned to either the experimental group or the control group. Interventions: The experimental group was subjected to 8 weeks of medicine ball plyometric training held thrice per week. Neuromuscular adaptations were analyzed pretraining and posttraining in 3 age groups: <18, 18–25, and >25 years. Analysis of variance was used to ascertain the training effects between and within the 6 subgroups, that is, age group <18 years (control and experimental), age group 18–25 years (control and experimental), and age group >25 years (control and experimental). Main outcome measures: Muscle activation, upper body balance, upper body power, and muscle strength. Results: Out of 59, 55 participants completed the study. Subjects aged <18 years (adolescents) showed significantly greater improvements than those from the groups 18–25 years and >25 years (adults) on upper body balance and upper body power. Significant improvements were observed in the experimental subjects of all age groups on their muscle activity of biceps brachii, upper body balance, and upper body power following medicine ball plyometric training. Conclusions: Though adolescent subjects were found to be more adaptive than adult subjects, experimental subjects showed significantly greater neuromuscular adaptations to medicine ball plyometric training than controls. These findings emphasize the need for coaches and athletic trainers to inculcate medicine ball plyometric exercises in training regimes of cricket players so as to improve their upper body performance.

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Jérôme Vaulerin, Frédéric Chorin, Mélanie Emile, Fabienne d’Arripe-Longueville and Serge S. Colson

Context: Firefighters participating in mandatory physical exercise sessions are exposed to a high risk of ankle sprain injury. Although both physiological and psychological risk factors have been identified, few prospective studies considered the complex interaction of these factors in firefighters. Objective: To prospectively determine whether intrinsic physical risk factors and work-related environments predict ankle sprains occurring during on-duty physical exercise in firefighters during an 8-month follow-up period. Design: Prospective. Setting: Fire Department and Rescue Service. Participants: Thirty-nine firefighters were selected based on convenience sampling. Intervention: Participants performed physical tests and completed questionnaires. Main Outcome Measures: Lower Quarter Y-Balance Test, Weight-Bearing Lunge Test, anthropometric measures, postural stability, chronic ankle instability (Cumberland Ankle Instability Tool) scores, previous injuries, and perceived psychosocial work environment (Copenhagen Psychosocial Questionnaire [COPSOQ]). Results: During the follow-up, 9 firefighters sustained an injury. Lower Quarter Y-Balance Test and Weight-Bearing Lunge Test performances, Cumberland Ankle Instability Tool scores, history of previous ankle sprain, and specific dimensions of the COPSOQ significantly differed between injured and uninjured firefighters. Lower-limbs asymmetries of the Lower Quarter Y-Balance Test (ie, anterior, posteromedial, and posterolateral directions) and the Weight-Bearing Lunge Test were predictors of ankle sprains. Conclusions: These findings originally provide evidence that intrinsic factors mainly contribute to ankle sprains, although psychosocial work environment assessment could also characterize firefighters at risk.

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Rodrigo Rodrigues Gomes Costa, Rodrigo Luiz Carregaro and Frederico Ribeiro Neto

Context: There seems to be no consensus on which aspects better distinguish the different levels of spinal cord injury regarding body composition, strength, and functional independence. Objective: The study aimed to determine which variables better differentiate tetraplegia (TP) from paraplegia and high paraplegia (HP) from low paraplegia (LP). Design: Cross-sectional study. Setting: Rehabilitation hospital network. Patients: Forty-five men with spinal cord injury, n = 15 for each level (TP, HP, and LP) causing complete motor impairment (American Spinal Injury Association Impairment Scale: A or B) were enrolled in the study. Main Outcome Measures: The 1-maximum repetition test, functional independence measure, spinal cord independence measure, and body composition (skinfold sum, body fat percentage, and body mass index) were assessed. Discriminant analysis was carried out using the Wilks lambda method to identify which strength and functional variables can significantly discriminate subjects for injury classification (TP, HP, and LP). Results: The discriminant variable for TP versus HP was body mass index and for TP versus LP was 1-maximum repetition (P ≤ .05). There were no variables that discriminated HP versus LP. Conclusions: The discriminant variables for TP versus HP and TP versus LP were body mass index and 1-maximum repetition, respectively. The results showed that HP and LP are similar for strength and functional variables.

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Abby L. Cheng, John A. Merlo, Devyani Hunt, Ted Yemm, Robert H. Brophy and Heidi Prather

Context: Although elite adolescent female soccer athletes have unique injury risk factors and management challenges, limited epidemiological data exist for this population. Objective: To describe lower-body injury patterns and to determine whether a screening hip physical examination is predictive of future injuries in elite adolescent female soccer athletes. Design: Prospective cohort study. Setting: One US premier soccer club. Participants: One hundred seventy-seven female soccer athletes aged 10–18 years (mean [SD] 14.6 [1.8] y) completed a demographic questionnaire and screening hip physical examination that included range of motion and provocative tests. Interventions: At least 5 years after baseline screening, athletes completed an electronic follow-up injury survey. Injury was defined as pain that interfered with sporting activity. Main Outcome Measures: In addition to descriptive analyses of athletes’ injury profiles, associations between players’ baseline demographics and subsequent injury profiles were evaluated using chi-square tests, and potential predictors of injury based on players’ baseline hip examinations were evaluated using multivariable logistic regression. Results: Ninety-four of 177 athletes (53%) were contacted for follow-up, and 88/94 (93.6%) completed the survey. With mean follow-up of 91.9 (9.3) months (range 66–108 mo), 42/88 (47.7%) reported sustaining a new lower-body injury. The low back was the most common injury region (16/42, 38.1%). Almost half of all injured athletes (20/42, 47.6%) sustained overuse injuries, and 16/42 (38.1%) had an incomplete recovery. Higher body mass index and reaching menarche were associated with sustaining an injury (P = .03 and .04, respectively). Athletes’ baseline hip examinations were not predictive of their subsequent rate of lower-body, lumbopelvic, overuse, or incomplete recovery injury (all P > .05). Conclusions: Lower-body injuries were common in elite adolescent female soccer athletes, with over one third of injured athletes reporting permanent negative impact of the injury on their playing ability. Baseline hip physical examinations were not associated with future injury rate.

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Priscila Tamplain, E. Kipling Webster, Ali Brian and Nadia C. Valentini

Assessment of the motor domain is a critical aspect of understanding motor development. Measurement of motor development is the baseline to understand potential delays and to promote the tools for change and improvement of this domain. This paper aims to reflect on the construct of motor development and the process of assessing motor performance. We review the use of assessments in motor development research and discuss issues of validity, reliability, sensitivity, and specificity. We appraise selected assessments, describe how the use of assessments changed over the periods of study in motor development, and examine the contemporary status of assessments and its applications. Finally, and most importantly, we provide suggestions and recommendations for future directions in the field, as well as pose important questions for researchers and practitioners to consider when selecting, using, and interpreting assessment results. In light of the contemporary view of motor development and the increasing focus on health applications, we recommend the use of screening tools, short forms, and technology, as well as encouraging the use of and more research on motor development assessments in childhood.

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Kanako Shimoura, Yasuaki Nakayama, Yuto Tashiro, Takayuki Hotta, Yusuke Suzuki, Seishiro Tasaka, Tomofumi Matsushita, Keisuke Matsubara, Mirei Kawagoe, Takuya Sonoda, Yuki Yokota and Tomoki Aoyama

Context: The functional movement screen (FMS) is an assessment tool for movement dysfunction, which is used to reduce the risk of injury. Although the relationship between the FMS composite score and injuries has been extensively studied, the association between FMS scores and injuries in only college basketball players remains unknown. Objective: To examine the relationship between the FMS score and injuries in basketball players. Design: Cross-sectional study. Setting: University research laboratory. Participants: Eighty-one male college basketball players (average age 20.1 [1.3] y) participated. Main Outcome Measures: The FMS composite score was calculated from 7 movement tests. The incidence of injuries over a 1-year period prior to the test day was determined based on a questionnaire. Individuals were categorized into 2 groups: injury (with a serious basketball-related injury resulting in the loss of practice and game time for at least 4 wk) and noninjury groups. Mann–Whitney U and chi-square tests were used to evaluate group differences in the composite FMS and 7 movement scores, respectively. Furthermore, the scores significant on univariate analyses were submitted to a multivariate logistic analysis, adjusting for participant characteristics. Results: The composite FMS scores of the 2 groups were not significantly different (P = .38). Among the 7 tasks, only the deep squat and hurdle step showed significant group differences (P = .03 and P = .001, respectively). The multivariate logistic analysis revealed that deep squat (odds ratio, 6.48; 95% confidence interval, 1.23–34.01; P = .03) and hurdle step scores (odds ratio, 25.80; 95% confidence interval, 1.81–368.73; P = .02) were significantly associated with injuries, even after adjustment for participant characteristics. Conclusions: Deep squat and hurdle step scores may be associated with injuries in basketball players. Further research should be conducted to confirm that these 2 scores can predict the incidence of injuries in basketball players.

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Natalie L. Myers, Guadalupe Mexicano and Kristin V. Aguilar

Clinical Scenario: Workload monitoring and management of an athlete is viewed by many as an essential training component to determine if an athlete is adapting to a training program and to minimize injury risk. Although training workload may be measured a variety of different ways, session rate of perceived exertion (sRPE) is often used in the literature due to its clinical ease. In recent years, sports scientists have been investigating sRPE as a measure of internal workload and its relationship to injury in elite-level athletes using a metric known as the acute:chronic workload ratio (ACWR). This critically appraised topic was conducted to determine if internal workload using the ACWR is associated with injury. Focused Clinical Question: In elite-level athletes, is there an association between the ACWR for sRPE and noncontact injuries? Summary of Search, Best Evidence Appraised, and Key Findings: The literature was searched for studies investigating the association between noncontact injuries and the sRPE ACWR in elite athletes. Three prospective cohort studies were included. Two studies found that high ACWR led to 2.0 to 4.5 times greater injury risk compared with a more balanced ACWR. One study found that low chronic workloads coupled with a low ACWR were associated with injury. Clinical Bottom Line: The majority of evidence suggests that when the acute workload exceeds the chronic workload, there is an increase in injury risk. The evidence also supports that a low chronic workload with a low ACWR should be considered as an injury risk factor. Strength of Recommendation: Based on the American Family Physician’s Strength of Recommendation Taxonomy, there is level A evidence to support the sRPE ACWR as a risk factor for noncontract injuries in elite athletes.

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Akio Kubota, Alison Carver and Takemi Sugiyama

This cross-sectional study examined associations of local social engagement with walking and sitting, and whether these associations were modified by local environmental attributes. Older residents (aged 65–84 years, n = 849), recruited from a regional city in Japan, reported walking frequency, sitting time, local social engagement, and local environmental attributes. Walk Score® was also used as an environmental measure. Analysis of data from 705 participants found that engaging in community activities was significantly associated with more frequent walking, but not with prolonged sitting. Interaction analyses between social engagement and environmental attributes did not show any significant interactions, suggesting that promoting local social engagement may increase walking frequency among older adults, regardless of local environmental characteristics. Community-level social initiatives that encourage older adults to participate in local meetings, events, and activities may be an effective physical activity promotion strategy among older adults.