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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Josep C. Benítez-Martínez, Pablo Martínez-Ramírez, Fermín Valera-Garrido, Jose Casaña-Granell and Francesc Medina-Mirapeix
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.
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.
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.
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.
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.
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.
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.
Kailin C. Parker, Rachel R. Shelton and Rebecca M. Lopez
Clinical Scenario: In the last few years, there have been several studies examining alternative cooling strategies in the treatment of exertional heat stroke (EHS). Morbidity and mortality with EHS are associated with how long the patient’s core body temperature remains above the critical threshold of 40.5°C. Although cold-water immersion (CWI) is the gold standard of treatment when cooling a patient with EHS, more recent alternative cooling techniques have been examined for use in settings where CWI may not be feasible (ie, remote locations). Clinical Question: Do alternative cooling methods have effective core body temperature cooling rates for hyperthermia compared with previously established CWI cooling rates? Summary of Key Findings: The authors searched for studies using alternative cooling methods to cool hyperthermic individuals. To be included, the studies needed a PEDro score ≥6 and a level of evidence ≥2. They found 9 studies related to our focused clinical question; of these, 5 studies met the inclusion criteria. The cooling rates for hand cooling, cold-water shower, and ice-sheet cooling were 0.03°C/min, 0.08°C/min, and 0.06°C/min, respectively, whereas the tarp-assisted cooling with oscillation (TACO) method was the only method that had an acceptable cooling rate (range 0.14–0.17°C/min). Clinical Bottom Line: When treating EHS, if CWI is not available, the tarp-assisted cooling method may be a reasonable alternative. Clinicians should not use cold shower, hand cooling, or ice-sheet cooling if better cooling methods are available. Clinicians should always use CWI when available. Strength of Recommendation: Five level 2 studies with PEDro scores ≥6 suggest the TACO method is the only alternative cooling method that decreases core body temperature at a similar, though slower, rate of CWI. Hand cooling, cold showering, and ice-sheet cooling do not decrease core body temperature at an appropriate rate and should not be used in EHS situations if a modality with a better cooling rate is available.
Özlem Feyzioğlu, Özgul Öztürk, Bilsen Sirmen and Selim Muğrabi
Context: Although many researchers have investigated the functional outcomes of different accelerated rehabilitation programs after anterior cruciate ligament reconstruction (ACLR), the functional results of the same accelerated rehabilitation program following ACLR applied for both elite athletes and nonathletes have not yet been investigated. Objective: To examine the effects of the same accelerated anterior cruciate ligament rehabilitation program on pain and functionality of elite athletes and nonathletes. Design: Prospective preintervention–postintervention design. Setting: Physiotherapy department. Participants: Fifteen elite athletes and 15 nonathletes who underwent unilateral ACLR with autologous hamstring tendon graft. Intervention: All participants received the same protocol for 6 weeks (5 sessions in a week). Main Outcome Measures: Primary measurements were pain intensity, which was measured by visual analog scale, range of motion measurement using universal goniometer, and functionality, which was detected by Lysholm score. Secondary measurements were short form-36 and Beck Depression Inventory. Results: Higher Lysholm (P = .001) and Beck Depression Inventory (P = .03) scores were observed in the elite athlete group, and higher pain (P = .001) was observed in the nonathlete group at baseline assessments. Significant improvement detected for pain (P < .05), knee flexion range (P < .05), Lysholm score (P < .05), and Beck Depression Inventory (P < .05) compared with preintervention for both groups. Finally, after comparing the mean change values, the nonathlete group displayed greater decrease in pain level (P = .01) and participants in the elite athlete group further showed a greater decrease in depression level (P = .001). Conclusions: This study found that the same accelerated rehabilitation protocol provides significant improvements for pain, functionality, and depression in both elite athletes and nonathletes after ACLR. Clinicians should consider our results when applying an anterior cruciate ligament rehabilitation program for nonathlete groups.