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David Cruz-Díaz, Kyung-Min Kim, Fidel Hita-Contreras, Marco Bergamin, Agustin Aibar-Almazán and Antonio Martínez-Amat

Context: Tai Chi is a physical activity modality which is widely practiced over the world. The effectiveness of Tai Chi on postural control and balance has been described in older population, but until recently there are no studies that include patients with chronic ankle instability. Objectives: The aim of this study was to evaluate the effectiveness of 12 weeks of Tai Chi intervention on dynamic balance and self-reported instability in patients with chronic ankle instability. Study Design: A randomized controlled trial was carried out. Setting: University physical therapy facility. Participants: Fifty-two participants were allocated to an intervention group (n = 26) based on Tai Chi training or a control group (n = 26) who received no intervention. Intervention: The participants completed 12 weeks of Tai Chi intervention (1 h session/2 times per week) or no intervention in the control group. Main Outcome Measures: Outcome measures included postural control and self-reported instability feeling assessed by the Star Excursion Balance Test and the Cumberland Ankle Instability Tool, respectively. Results: There was observed significant improvement in all Star Excursion Balance Test reach distances (anterior [F = 6.26, P < .01]; posteromedial [F = 9.58, P < .01], and posterolateral [F = 8.42, P < .01]) in the Tai Chi group with no change in the control group (P < .01). The intervention group demonstrated significant improvement on self-reported instability feeling assessed by the Cumberland Ankle Instability Tool questionnaire (F = 21.36, P < .01). Conclusion: The obtained results suggested that 12 weeks of Tai Chi intervention have positive effects on postural control and self-reported instability feeling in patients with chronic ankle instability.

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Jose A. Cecchini and Alejandro Carriedo

Purpose: New ways of teaching have been under consideration over the last decade. Thus, this study aims to examine the effects of an interdisciplinary educational approach integrating physical education and mathematics on light and moderate–vigorous physical activity (PA), sedentary behavior, and learning subtraction. Method: Forty-six first-grade students (M age = 76.98 ± 3.74 months) wore an accelerometer for 4 weeks to measure their PA levels. For 3 weeks, one group (n = 23) attended their physical education and mathematic lessons separately according to the traditional curriculum development (i.e., regular classroom lessons), and the other group (n = 23) was taught through an integrated curriculum based on an interdisciplinary approach integrating physical education and mathematics where the curricular time devoted to these subjects was unified. Results: Several t-test analyses revealed significant between-group differences in all variables following the curricular interventions. Students from the interdisciplinary group reached higher levels of light PA, t(44) = −10.095, p < .001, d = 2.97; moderate–vigorous PA, t(44) = −7.950, p < .001, d = 2.35; and spent less time in sedentary behavior, t(44) = 13.549, p < .001, d = 4.01, than students who attended regular classroom lessons. Moreover, the students from the interdisciplinary group achieved higher scores in subtraction learning, t(44) = −4.06, p < .001, d = 1.20. Discussion/Conclusion: The integration of PA into learning environments such as mathematics might help to develop tools that improve mathematical learnings (i.e., subtraction). Likewise, this kind of interdisciplinary approach may contribute to increase the children’s PA levels during the school day.

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Dae-Hyun Kim, Jin-Hee Lee, Seul-Min Yu and Chang-Man An

Context: It is very important to empirically determine the optimal ankle position for the quadriceps femoris (QF) strengthening during isometric exercises. Objective: To examine the effect of different ankle positions on torque and electromyography (EMG) activity of QF during maximal isometric contraction. Study Design: Within-subject repeated measures. Setting: University laboratory. Participants : Thirty-six healthy volunteers (15 males and 21 females). Main Outcome Measures: The isometric strength of the QF was measured at 3 different ankle positions: active dorsiflexion (AD), active plantar flexion (AP), and neutral position (NP). Simultaneously, 3 different ankle positions were assessed for EMG activity of the vastus medialis, vastus lateralis, and rectus femoris muscles during maximal voluntary isometric contraction. Results: The peak torque per body weight and average peak torque were significantly higher in AD than in AP and NP (P < .01). The vastus medialis and rectus femoris maximal voluntary isometric contraction EMG activity were significantly higher in AD than in AP and NP (P < .01). The vastus lateralis maximal voluntary isometric contraction EMG activity was significantly higher in AD than in AP and NP (P < .01), and was significantly higher in AP than in NP (P < .05). Conclusions: These results indicate that the 3 different ankle positions affect the QF torque and EMG activity. In particular, AD position may be more efficient for improving QF strength than AP and NP position. Future studies should prove whether long-term duration QF isometric exercise effects muscle strength and functional performance in different ankle positions.

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Louisa D. Raisbeck, Jed A. Diekfuss, Dustin R. Grooms and Randy Schmitz

Context: Although the beneficial effects of using an external focus of attention are well documented in attainment and performance of movement execution, neural mechanisms underlying external focus’ benefits are mostly unknown. Objective: To assess brain function during a lower-extremity gross motor movement while manipulating an internal and external focus of attention. Design: Cross-over study. Setting: Neuroimaging center Participants: A total of 10 healthy subjects (5 males and 5 females) Intervention: Participants completed external and internal focus of attention unilateral left 45° knee extension/flexion movements at a rate of 1.2 Hz laying supine in a magnetic resonance imaging scanner for 4 blocks of 30 seconds interspersed with 30-second rest blocks. During the internal condition, participants were instructed to “squeeze their quadriceps.” During the external condition, participants were instructed to “focus on a target” positioned above their tibia. Main Outcome Measures: T1 brain structural imaging was performed for registration of the functional data. For each condition, 3T functional magnetic resonance imaging blood oxygenation level dependent data representing 90 whole-brain volumes were acquired. Results: During the external relative to internal condition, increased activation was detected in the right occipital pole, cuneal cortex, anterior portion of the lingual gyrus, and intracalcarine cortex (Z max = 4.5–6.2, P < .001). During the internal relative to external condition, increased activation was detected in the left primary motor cortex, left supplementary motor cortex, and cerebellum (Z max = 3.4–3.5, P < .001). Conclusions: Current results suggest that an external focus directed toward a visual target produces more brain activity in regions associated with vision and ventral streaming pathways, whereas an internal focus manipulated through instruction increases activation in brain regions that are responsible for motor control. Results from this study serve as baseline information for future prevention and rehabilitation investigations of how manipulating focus of attention can constructively affect neuroplasticity during training and rehabilitation.

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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.