Context: Decreased postural balance is a primary risk factor for lower-limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at halftime. Its effect on dynamic postural balance remains unclear. Objective: To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically oriented outcome measure. Design: Experimental study. Setting: University biomechanics laboratory. Patients or Participants: A total of 28 elite-level college male field-sport athletes. Intervention: Participants were tested on the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test both before and after a 15-minute knee joint cryotherapy application. Main Outcome Measure(s): Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension of the center-of-pressure path during the performance of the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test. Results: There was a statistically significant decrease in reach distance scores achieved on anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test from precryotherapy to postcryotherapy (P < .05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee, or ankle joint kinematics (P > .05). No significant change in fractal dimension was observed for any reach direction following cryotherapy application (P > .05). Conclusions: The results of the present study indicate that dynamic postural balance is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.
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Karl Fullam, Brian Caulfield, Garrett F. Coughlan, Wayne McNulty, David Campbell and Eamonn Delahunt
Dai Sugimoto, Benton E. Heyworth, Brandon A. Yates, Dennis E. Kramer, Mininder S. Kocher and Lyle J. Micheli
Context: To treat anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) surgery is currently a standard of the care. However, effect of graft type including bone–patellar tendon–bone (BTB), hamstring tendon, or iliotibial band (ITB) on thigh size, knee range of motion (ROM), and muscle strength are understudied. Objective : To compare postoperative thigh circumference, knee ROM, and hip and thigh muscle strength in adolescent males who underwent ACLR, based on the 3 different autograft types: BTB, hamstring (HS), and ITB. Setting: Biomechanical laboratory. Participants: Male ACLR patients who are younger than 22 years of age (total N = 164). Intervention: At 6- to 9-month postoperative visits, thigh circumference, knee ROM, and hip and thigh muscle strength were measured. Main Outcome Measures: Deficits of each variable between the uninvolved and ACLR limb were compared for pediatric and adolescent ACLR males in the BTB, HS, and ITB cohorts. Baseline characteristics, including physical demographics and meniscus tear status, were compared, and differences identified were treated as covariates and incorporated in analysis of covariance. Results: Data were from 164 adolescent male ACLR patients [mean age 15.7 (1.2) years]. There were no statistical differences in thigh circumference, knee ROM, hip abductor, and hip-extensor strength among the 3 autografts. However, patients with BTB demonstrated 12.2% deficits in quadriceps strength compared with 0.5% surplus in HS patients (P = .002) and 1.2% deficits in ITB patients (P = .03). Patients with HS showed 31.7% deficits in hamstring strength compared with 5.4% deficits in BTB (P = .001) and 7.7% deficits in ITB (P = .001) groups at 6- to 9-month postoperative visits. Conclusion: Adolescent male ACLR patients with BTB and HS autografts demonstrated significant deficits in quadriceps and hamstring strength, respectively, at 6 to 9 months postoperatively. Minimal lower-extremity strength deficits were demonstrated in pediatric male ACLR patients undergoing ITB harvest.
Hong-Wen Wu, Cheng-Feng Tsai, Kai-Han Liang and Yi-Wen Chang
Context: Squats and lunges are common exercises frequently applied in muscle-strengthening and therapeutic exercises. The loading devices are often used to increase the training intensity. Objective: To determine the effect of loading devices on muscle activation in squat and lunge and to compare the differences in muscle activation between squat and lunge. Design: Cross-sectional cohort. Participants: Nineteen healthy, male, recreationally active individuals without a history of lower limb injury. Interventions: Each participant performed 10 repetitions of a squat under 5 conditions: unloaded, barbell, dumbbell, loaded vest, and kettlebell, and 10 repetitions of a lunge under 4 conditions: unloaded, barbell, dumbbell, and loaded vest. Main Outcome Measures: The electromyography signals of quadriceps, hamstrings, tibialis anterior, gastrocnemius lateralis and medialis were measured. One-way repeated-measure analysis of variance was used to compare the difference among different loading conditions. Paired t test was used to compare the difference between squat and lunge. Results: The muscle activation in the loaded conditions was significantly higher than that in nonloaded conditions in squat and lunge. Compared with the barbell, dumbbell, and loaded vest conditions, the semitendinosus showed significantly higher activation, and the tibialis anterior showed significantly lower activation in kettlebell condition in squat. No significant difference in muscle activation was found among barbell, dumbbell, and kettlebell conditions in lunge. In addition, quadriceps and hamstring activities were significantly higher in lunge than in squat. Conclusions: Muscle activation was affected by the loading devices in squat but not affected in lunge. Kettlebell squat could be suggested for targeting in strengthening medial hamstring. Progressive strengthening exercise could be recommended from squat to lunge based on sequential activation level.
Hiroshi Takasaki, Yu Okubo and Shun Okuyama
Context: Accurate joint position sense (JPS) is necessary for effective motor learning and high performance in activities that require fine motor control. Proprioceptive neuromuscular facilitation (PNF) can be a promising intervention. Objective: To examine existing peer-reviewed original studies that have investigated the effect of PNF techniques on the JPS in terms of the methodological quality, PNF techniques, outcomes, and participant characteristics. Evidence Acquisition: A systematic literature search was performed using PubMed, EMBASE, MEDLINE, CINAHL, SocINDEX, Scopus, and Cochrane Library from inception to January 2018. The following inclusion criteria were used: (1) assessment of the JPS; (2) peer-reviewed original studies with a randomized controlled trial or quasi-randomized controlled trial design; (3) participants with musculoskeletal disorders or healthy individuals (ie, neither animal studies nor those involving neurological problems); and (4) no cointervention with PNF, except for warm-up procedures. The methodological quality was assessed using PEDro scale and 5 additional criteria. Effect size (η 2) was calculated where a positive value indicated an increased JPS after PNF as compared with other approaches including the wait-and-see method. Evidence Synthesis: Nine studies were examined for their methodological quality, and only one study scored >6 on the PEDro scale. Positive and large effect size (η 2 > .14) was detected in 2 studies where JPS of the knee with contract-relax and replication techniques was assessed in healthy individuals. However, the methodological quality of these studies was poor (PEDro scores of 3 and ≤5 in the total quality score out of 16, respectively). Conclusions: The current study did not find multiple studies with high methodological quality and similar PNF techniques, outcomes, and characteristics of participants. More high-quality studies are required to achieve a comprehensive understanding of the effect of PNF on the JPS.
Masatoshi Nakamura, Shigeru Sato, Ryosuke Kiyono, Nobushige Takahashi and Tomoichi Yoshida
Context: In clinical and sports settings, static stretching (SS) is usually performed to increase range of motion (ROM) and decrease passive muscle stiffness. Recently, the shear elastic modulus was measured by ultrasonic shear wave elastography as an index of muscle stiffness. Previous studies reported that the shear elastic modulus measured by ultrasound shear wave elastography decreased after SS, and the effects of SS on shear elastic modulus were likely affected by rest duration between sets of SS. Objective: To investigate the acute effects of SS with different rest durations on ROM and shear elastic modulus of gastrocnemius and to clarify whether the rest duration between sets of SS decreases the shear elastic modulus. Design: A randomized, repeated-measures experimental design. Setting: University laboratory. Participants: Sixteen healthy males volunteered to participate in the study (age 21.3 [0.8] y; height 171.8 [5.1] cm; weight 63.1 [4.5] kg). Main Outcome Measures: Each participant underwent 3 different rest interval durations during SS (ie, long rest duration: 90 s; normal rest duration: 30 s; and short rest duration: 10 s). This SS technique was repeated 10 times, thus lasting a total of 300 seconds with different rest durations in each protocol. The dorsiflexion ROM and shear elastic modulus were measured before and after SS. Results: Our results revealed that dorsiflexion ROM and shear elastic modulus were changed after 300-second SS; however, no effects of the rest duration between sets of SS were observed. Conclusions: In terms of decreasing the shear elastic modulus, clinicians and coaches should not focus on the rest duration when SS intervention is performed.
Hadi Akbari, Mansour Sahebozamani, Ablolhamid Daneshjoo, Mohammadtaghi Amiri-Khorasani and Yohei Shimokochi
Context: There is no evidence regarding the effect of the FIFA 11+ on landing kinematics in male soccer players, and few studies exist regarding the evaluating progress of interventions based on the initial biomechanical profile. Objective: To investigate the effect of the FIFA 11+ program on landing patterns in soccer players classified as at low or high risk for noncontact anterior cruciate ligament injuries. Design: Randomized controlled trial. Setting: Field-based functional movement screening performed at the soccer field. Participants: A total of 24 elite male youth soccer players participated in this study. Intervention: The intervention group performed the FIFA 11+ program 3 times per week for 8 weeks, whereas the control group performed their regular warm-up program. Main Outcome Measures: Before and after the intervention, all participants were assessed for landing mechanics using the Landing Error Scoring System. Pretraining Landing Error Scoring System scores were used to determine risk groups. Results: The FIFA 11+ group had greater improvement than the control group in terms of improving the landing pattern; there was a significant intergroup difference (F
1,20 = 28.86, P < .001,
Blair Mills, Brad Mayo, Francisco Tavares and Matthew Driller
Context: Given the relatively novel technique of tissue flossing is currently lacking in the research literature despite some positive findings in preliminary studies, the modality clearly requires further research. Current evidence suggests that band flossing results in performance improvements and may also be an effective method in injury prevention. Objective: Previous research has shown that tissue flossing may result in increased ankle range of motion, jump, and sprinting performance in recreational athletes. The present study aims to extend on this research, within an elite athlete sample. Design: Counterbalanced, cross-over design with experimental and control trials, separated by 1 week. Setting: University laboratory. Participants: Fourteen professional male rugby union athletes (mean [SD]: age 23.9 [2.7] y). Intervention: Application of a floss band to both ankles (FLOSS) for 2 minutes or without flossing of the ankle joints (CON) on 2 separate occasions. Main Outcome Measures: A weight-bearing lunge test, a countermovement jump test, and a 20-m sprint test at pre and at 5 and 30 minutes post application of the floss band or control. Results: There were no statistically significant interactions between treatment (FLOSS/CON) and time for any of the measured variables (P > .05). Effect size analysis revealed small benefits for FLOSS in comparison with CON for countermovement performance 5 minutes post (d = 0.28) and for 10-m (d = −0.45) and 15-m (d = −0.24) sprint time 30 minutes post. Conclusion: Findings from the current study suggest minimal benefits of tissue flossing when applied to the ankle joint in elite athletes for up to 30 minutes following their application.
Afshin Moghadasi, Gholamali Ghasemi, Ebrahim Sadeghi-Demneh and Masoud Etemadifar
Context: Muscle weakness and sensory deficits cause impaired balance and walking abilities that are prerequisites for independent activity of daily living in people with multiple sclerosis (MS). Recent physical exercises tailored to improve the activity of daily living people with MS have focused on the functional training. Objective: To investigate the effect of total body resistance exercise suspension training on mobility, proprioception, and muscle strength of the knee in people with MS. Design: Single-blind pretest and posttest control group design. Setting: Referral Center of Multiple Sclerosis Society. Participants: Thirty-four women with relapsing–remitting MS were participated in this study. The mean (SD) of their age was 36.44 (4.88) years, and the Expanded Disability Status Scale was 2.35 (0.94). The participants were divided into 2 groups: control group (n = 15) and training group (n = 19). Intervention: The training group performed the total body resistance exercise program for 8 weeks, 3 sessions per week. The control group received their usual care and daily activities. Outcomes were measured presessions and postsessions. Main Outcome Measures: Mobility was assessed with Timed Up and Go test, 10-m walk maximum test, 2 minute walk test, and 5-time sit-to-stand test. Knee proprioception absolute error and isometric strength of knee flexor and extensor muscles were measured by using a biodex isokinetic dynamometer. Results: In the training group, mobility (P = .001), maximal voluntary isometric contraction of knee flexor and extensor muscles in both legs (P > .05), and the knee proprioception absolute error in nondominant leg at 60° knee flexion (P = .02) improved significantly compared with the control group. Conclusion: Total body resistance exercise is a functional and safe intervention that can improve the mobility and muscles strength of the knee in a short period in people with MS.
Mohamed Abdelmegeed, Everett Lohman, Noha Daher, June Kume and Hasan M. Syed
Context: In comparison with the published research on the surgical management of ulnar wrist pain, fewer studies that discuss the nonsurgical management of ulnar wrist pain exist. Objective: The purpose of this pilot study was to investigate the effect of ulnar-based wrist orthotics and strengthening exercises on subjects with ulnar wrist pain. Study Design: Prospective randomized controlled pilot study. Setting: Research laboratory. Participants: Thirty subjects with acute and subacute ulnar wrist pain and age ranging from 18 to 53. Interventions: Participants were randomized to receive either ulnar-based orthotics, ulnar-based orthotics plus strengthening exercises, or placebo intervention. Main Outcome Measures: The authors measured pain and function using the Patient-Rated Wrist Evaluation questionnaire, and grip strength using the JAMAR dynamometer, at baseline and at 2- and 4-week postrandomization. A mixed analysis of variance modeling was used to investigate the effect of the intervention over time. Results: There were statistically significant differences between the 2 intervention groups and the control group regarding improvement in pain, function, and strength, whereas there were no statistically significant differences between the 2 intervention groups over the 3 measurement occasions regarding the outcome measures. Conclusion: Based on the results, orthotics intervention is as effective as orthotics plus strengthening exercises in improving pain, function, and grip strength in subjects with ulnar wrist pain. Level of Evidence: Therapy, level 2b individual Randomized Controlled Trial.
Berkiye Kirmizigil, Jeffry Roy Chauchat, Omer Yalciner, Gozde Iyigun, Ender Angin and Gul Baltaci
Context: Kinesio taping (KT) is a popular taping technique used in the recovery process; however, in the relevant literature, there is no real consensus on its efficacy. Objective: To investigate whether rectus femoris KT application after delayed onset muscle soreness enhances recovery of muscle soreness, edema, and physical performance. Participants: A total of 22 healthy amateur male athletes participated in this study. Design: Randomized, crossover study. Setting: Human performance laboratory of the university. Interventions: Participants performed an exercise protocol inducing delayed onset muscle soreness. They accomplished 2 distinct trials, with or without KT. The washout period between trials was 6 weeks. For the KT condition, KT inhibition technique was used and applied immediately after exercise bilaterally on rectus femoris. Main Outcome Measures: Range of motion, muscle soreness, and edema were measured at baseline, 30 minutes, 24, 48, and 72 hours postexercise. Dynamic balance, sprint, and horizontal jump were evaluated at similar time frame except for 30-minute postexercise. Results: The findings showed that there were no significant differences between the KT group (KTG) and control group for all outcome variables (P > .05). Muscle soreness returned to baseline values 72 hours postexercise only within the KTG (P > .05). Although the horizontal jump performance decreased substantially from baseline to 24 and 48 hours postexercise only within the control group (P < .05), the performance increased significantly from 24 to 72 hours postexercise within the KTG (P < .05). Balance increased significantly from baseline to 48 hours postexercise (P < .05) in both groups. Balance also increased significantly from baseline to 72 hours postexercise only within the KTG (P < .05). The effect size of soreness which is our primary outcome was large in both groups (r > .5). Conclusions: KT is favorable in the recovery of muscle soreness after delayed onset muscle soreness. KT has beneficial effects on horizontal jump performance and dynamic balance.