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Orges Lena, Jasemin Todri, Ardita Todri, José Luis Martínez Gil and Maria Gomez Gallego

Context: One of the main reasons why athletes with a high physical condition suffer from low back pain disease is because they often participate in sports that involve disc compression movements during flexion, lifting loads, or torsion movement. Objectives: This study aims to examine the effectiveness of the postural treatment of the Mézières method on elite rhythmic gymnastics athletes with low back pain. Design: Double-blind, randomized, controlled trial. Setting: The sports hall of “Puente Tocinos,” Murcia, Spain. Participants: Ninety gymnastics athletes were randomized into 2 parallel groups (intervention: n = 39; control: n = 51), of whom 98.9% were women (women = 89; man = 1). Intervention: The Mézières method postural therapy was implemented. It lasted about 60 minutes in repeated sessions of 2 to 3 meetings per week by counting in overall 60 sessions during a 24-week period. Main Outcome Measures: Visual analog scale of pain, sit and reach flexibility test, Runtastic (pedometer performance android application), Roland–Morris Questionnaire for the physical disability, and the Health Status Questionnaire were used. Results: The univariate analysis of variance and independent sample t test revealed a significant improvement in the intervention group concerning the visual analog scale pain assessment scale (P < .05, ηp2=.625), and, also, the between-groups effect size was high during the 24 sessions of treatment (d > 0.8) compared with the control one. The same situation persists even for Roland–Morris Questionnaire (P < .05, ηp2=.802), physical score (P < .05, ηp2=.613), mental score (P < .05, ηp2=.736), sit and reach flexibility test (P < .05, ηp2=.666), and Runtastic performance (P < .05, ηp2=.790), where the between-groups effect size was high during the 24 sessions of treatment (d > 0.8). Conclusion: The Mézières method treatment performed on athletes with low back pain has caused positive effects on all the outcomes analyzed compared with the ones of control group.

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Marcie Fyock, Nelson Cortes, Alex Hulse and Joel Martin

Clinical Scenario: Patellofemoral pain (PFP) is a common knee injury in recreational adult runners, possibly caused by faulty mechanics. One possible approach to reduce this pain is to retrain the runner’s gait. Current research suggests that no definitive gold standard treatment for PFP exists. Gait retraining utilizing visual feedback may reduce PFP in both the short and long term. Clinical Question: In adult runners diagnosed with PFP, does gait retraining with real-time visual feedback lead to a decrease in pain? Summary of Key Findings: A literature search was performed; 3 relevant studies utilizing gait retraining with visual feedback, pain level as an outcome measure, and follow-up measures of at least 1 month after the intervention were included. All the included studies reported a decrease in short- and long-term pain for participants following visual feedback gait retraining. In addition, biomechanical measures related to PFP, including peak hip adduction angle and the angle of contralateral pelvic drop, improved after the completion of the intervention. Clinical Bottom Line: There is level 2 evidence supporting the implementation of 8 sessions over 2 weeks of visual feedback gait retraining as a means of treating patients diagnosed with PFP. Based on current available evidence, clinicians should identify faulty mechanics of patients and implement a protocol of increasing real-time visual feedback over the first 4 sessions and decreasing visual feedback over the final 4 sessions. Strength of Recommendation: Level 2.

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Nicola Marotta, Andrea Demeco, Gerardo de Scorpio, Angelo Indino, Teresa Iona and Antonio Ammendolia

Context: Activation time of the quadriceps is important in determining injury risk in professional soccer players. Objective: To compare the activation time of the quadriceps and hamstrings muscles during a movement that puts stress on anterior cruciate ligament (ACL) to assess the risk of ACL injury. Design: Case series. Setting: University laboratory for movement analysis. Patients or Other Participants: Twenty (10 males and 10 females) professional soccer players. Intervention(s): An inertial sensor and 4 electrodes positioned on the quadriceps and hamstrings muscles were used for the surface electromyography. The athlete resting on 1 leg dropped, from a 32-cm-high platform, on the suspended foot (testing leg), without jumping or lowering his center of gravity and maintaining single-leg landing for 5 seconds. Using a software, it is possible to calculate the activation time of the rectus femoris, vastus medialis (VM), biceps femoris, and semimembranosus muscles before ground contact. Main Outcome Measures: To evaluate the activation times of the rectus femoris, VM, biceps femoris, and semitendinosus muscles before ground contact in comparison with the range of normality calculated by the manufacturer. Results: All male soccer players demonstrated a low risk related to the correct activation of all the examined muscles, while female soccer players demonstrated delayed activation of the VM. Conclusions: Delayed activation of the VM registered in females determines an increase in anterior shear force, which is an important risk factor for incurring an ACL injury. This testing protocol becomes adequate for the screening of high-risk athletes and for targeting interventions to specific imbalances that may increase injury risk.

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Frank E. DiLiberto and Deborah A. Nawoczenski

Although the midfoot is recognized to have an important role in the successful performance of a single-limb heel rise, healthy heel rise performance remains primarily characterized by ankle function. The purpose of this study was to examine the contribution of midfoot region power to single-limb heel rise in healthy adults. Participants (N = 12) performed 20 single-limb heel rises. An electromagnetic motion capture system and a force plate were used to record 3-segment foot motion and ground reaction forces. Inverse dynamic calculations were performed to obtain ankle and midfoot region powers. These data were evaluated with descriptive statistics. A correlation was performed to evaluate the contribution of midfoot region power to heel height, as heel height is a clinical measure of heel-rise performance. The midfoot contributed power during single-limb heel rise (peak positive power: 0.5 [0.2] W·kg−1). Furthermore, midfoot peak power accounted for 36% of the variance in heel height (P = .04). As energy generating internal mechanisms, such as muscle activity, are attributed to power generation, midfoot tissue loading and muscle performance should be considered during clinical and modeling applications of the heel-rise task.

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Marlowe Pecora, Luc Tremblay and Matthew Heath

Reaches with overlapping stimulus-response spatial relations (propointing) adhere to speed–accuracy relations as defined by Paul Fitts’ index of difficulty equation (IDFitts: in bits of information). This movement principle is attributed to response mediation via the “fast” visuomotor networks of the dorsal visual pathway. It is, however, unclear whether the executive demands of dissociating stimulus-response spatial relations by reaching mirror-symmetrical to a target (antipointing) elicits similar adherence to Fitts’ equation. Here, pro- and antipointing responses were directed to a constant target amplitude with varying target widths to provide IDFitts values of 3.0, 3.5, 4.3, and 6.3 bits. Propointing movement times linearly increased with IDFitts—a result attributed to visually based trajectory corrections. In contrast, antipointing movement times, deceleration times, and endpoint precision did not adhere to Fitts’ equation. These results indicate that antipointing renders a “slow” and offline mode of control mediated by the visuoperceptual networks of the ventral visual pathway.

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Jonathon R. Staples, Kevin A. Schafer, Matthew V. Smith, John Motley, Mark Halstead, Andrew Blackman, Amanda Haas, Karen Steger-May, Matthew J. Matava, Rick W. Wright and Robert H. Brophy

Context: Patients with anterior cruciate ligament (ACL) tears are likely to have deficient dynamic postural stability compared with healthy sex- and age-matched controls. Objectives: To test the hypothesis that patients undergoing ACL reconstruction have decreased dynamic postural stability compared with matched healthy controls. Design: Prospective case-control study. Setting: Orthopedic sports medicine and physical therapy clinics. Patients or Other Participants: Patients aged 20 years and younger with an ACL tear scheduled for reconstruction were enrolled prospectively. Controls were recruited from local high schools and colleges via flyers. Interventions: Patients underwent double-stance dynamic postural stability testing prior to surgery, recording time to failure and dynamic motion analysis (DMA) scores. Patients were then matched with healthy controls. Main Outcome Measures: Demographics, time to failure, and DMA scores were compared between groups. Results: A total of 19 females and 12 males with ACL tears were matched with controls. Individuals with ACL tears were more active (Marx activity score: 15.7 [1.0] vs 10.8 [4.9], P < .001); had shorter times until test failure (84.4 [15.8] vs 99.5 [14.5] s, P < .001); and had higher (worse) DMA scores (627 [147] vs 481 [132], P < .001), indicating less dynamic postural stability. Six patients with ACL deficiency (1 male and 5 females) demonstrated lower (better) DMA scores than their controls, and another 7 (4 males and 3 females) were within 20% of controls. Conclusions: Patients undergoing ACL reconstruction had worse global dynamic postural stability compared with well-matched controls. This may represent the effect of the ACL injury or preexisting deficits that contributed to the injury itself. These differences should be studied further to evaluate their relevance to ACL injury risk, rehabilitation, and return to play.

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Niranjan Chakrabhavi and Varadhan SKM

A task involving an instructed finger movement causes involuntary movements in the noninstructed fingers of the hand, also known as finger interdependence. It is associated with both mechanical and neural mechanisms. The current experiment investigated the effect of finger interdependence due to systematic changes of the wrist posture, close to neutral. Eight right-handed healthy human participants performed submaximal cyclic flexion and extension at the metacarpophalangeal joint at 0° neutral, 30° extension, and 30° flexion wrist postures, respectively. The experiment comprised of an instruction to move one of the 4 fingers—index, middle, ring, and little. Movements of the instructed and noninstructed fingers were recorded. Finger interdependence was quantified using enslavement matrix, individuation index, and stationarity index, and it was compared across wrist postures. The authors found that the finger interdependence does not change with changes in wrist posture. Further analysis showed that individuation and stationarity indices were mostly equivalent across wrist postures, and their effects were much smaller than the average differences present among the fingers. The authors conclude that at wrist postures close to neutral, the finger interdependence is not affected by wrist posture.

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Lauren Anne Lipker, Caitlyn Rae Persinger, Bradley Steven Michalko and Christopher J. Durall

Clinical Scenario: Quadriceps atrophy and weakness are common after anterior cruciate ligament reconstruction (ACLR). Blood flow restriction (BFR) therapy, alone or in combination with exercise, has shown some promise in promoting muscular hypertrophy. This review was conducted to ascertain the extent to which current evidence supports the use of BFR for reducing quadriceps atrophy following ACLR in comparison with standard care. Clinical Question: Is BFR more effective than standard care for reducing quadriceps atrophy after ACLR? Summary of Key Findings: The literature was searched for studies that directly compared BFR treatment to standard care in patients with ACLR. Three level I randomized control trial studies retrieved from the literature search met the inclusion criteria. Clinical Bottom Line: Reviewed data suggest that a short duration (13 d) of moderate-pressure BFR combined with low-resistance muscular training does not appear to measurably affect quadriceps cross-sectional area. However, a relatively long duration (15 wk) of moderate-pressure BFR combined with low-resistance muscular training may increase quadriceps cross-sectional area to a greater extent than low-resistance muscular training alone. The results of the third randomized control trial suggest that employing BFR while immobilized in the early postoperative period may reduce quadriceps atrophy following ACLR. Additional data are needed to establish if the benefits of BFR on quadriceps atrophy after ACLR outweigh the inherent risks and costs. Strength of Recommendation: All evidence for this review was level 1 (randomized control trial) based on the Centre for Evidence-Based Medicine criteria. However, the findings were inconsistent across the 3 studies regarding the effects of BFR on quadriceps atrophy resulting in a grade “B” strength of recommendation.

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Zakariya Nawasreh, David Logerstedt, Adam Marmon and Lynn Snyder-Mackler

Context: Manual perturbation training improves knee functional performance and mitigates abnormal gait in patients with anterior cruciate ligament (ACL) rupture. However, manual perturbation training is time- and labor-intensive for therapists. Objective: To investigate whether perturbation training administered using a mechanical device can provide effects similar to manual training on clinical measures and knee biomechanics after ACL rupture. Design: Prospective cohort (therapeutic) study. A 2 × 2 analysis of variance was used for statistical analysis. Setting: A clinical and biomechanical laboratory. Patients: Eighteen level I/II patients with acute ACL ruptures participated in this preliminary study. Intervention: Nine patients received mechanical perturbation training on an automated mechanical device (mechanical group), and 9 patients received manual perturbation training (manual group). Outcome Measures: Patients completed performance-based testing (quadriceps strength and single-legged hop tests), patient-reported questionnaires (Knee Outcome Survey-Activities of Daily Living Scale, Global Rating Score, and International Knee Documentation Committee 2000), and 3-dimensional gait analysis before (pretesting) and after (posttesting) training. Results: There was no significant group-by-time interaction found for all measures (P ≥ .18). Main effects of time were found for International Knee Documentation Committee 2000 (pretesting: 69.10 [10.95], posttesting: 75.14 [7.19]), knee excursion during weight-acceptance (pretesting: 16.01° [3.99°]; posttesting: 17.28° [3.99°]) and midstance (pretesting: 14.78° [4.13°]; posttesting: 16.92° [4.53°]) and external knee-flexion moment (pretesting: 0.43 [0.11] N m/kg/m; posttesting: 0.48 [0.11] N m/kg/m) (P ≤ .04). After accounting for pretesting groups’ differences, the mechanical group scored significantly higher on triple hops (mechanical: 96.73% [6.65%]; manual: 84.97% [6.83%]) and 6-m timed hops (mechanical: 102.07% [9.50%]; manual: 91.21 [9.42%]) (P ≤ .047) compared with manual group. Conclusion: The clinical significance of this study is the mechanical perturbation training produced effects similar to manual training, with both training methods were equally  effective at improving patients’ perception of knee function and increasing knee excursion and external flexion moment during walking after acute ACL rupture. Mechanical perturbation training is a potential treatment to improve patients’ functional and biomechanical outcomes after ACL rupture.

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Jessica Ferreira, André Bebiano, Daniel Raro, João Martins and Anabela G. Silva

Context: Sliding and tensioning neural mobilization are used to restore normal function of the nervous system, but they impose different stresses on it. Particularly, sliding induces greater nerve excursion than tensioning. Conceivably, they might impact nervous system function differently. Objective: To compare the effects of tensioning neural mobilization versus sliding neural mobilization of the dominant lower limb on static postural control and hop testing. Design: Randomized, parallel and double blinded trial. Setting/Participants: Thirty-seven football players. Intervention(s): Participants were randomized into 2 groups: sliding neural mobilization (n = 18) or tensioning neural mobilization (n = 19) targeting the tibial nerve. Main Outcome Measures: Static postural sway was assessed with a force plate and functional performance with hop tests. Measurements were taken at baseline, after the intervention, and at 30-minute follow-up. Results: There was a significant effect of time for the center of pressure total displacement and velocity (P < .05), for the single-leg hop test (P < .05), the 6-m timed hop test (P < .05), and the cross-over hop test (P < .05), but no significant effect of the intervention. Conclusions: Sliding and tensioning neural mobilization improved postural control and hop testing in football players, and improvements remained 30 minutes after the intervention. Additional research examining the influence of neural mobilization on sensory motor impairments, postural control, and functional performance is needed.