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Joseph B. Lesnak, Dillon T. Anderson, Brooke E. Farmer, Dimitrios Katsavelis and Terry L. Grindstaff

Context: Resistance training exercise prescription is often based on exercises performed at a percentage of a 1-repetition maximum (1RM). Following knee injury, there is no consensus when a patient can safely perform 1RM testing. Resistance training programs require the use of higher loads, and loads used in knee injury rehabilitation may be too low to elicit gains in strength and power. A maximum isometric contraction can safely be performed during early stages of knee rehabilitation and has potential to predict an isotonic knee extension 1RM. Objective: To determine whether a 1RM on an isotonic knee extension machine can be predicted from isometric peak torque measurements. Design: Descriptive laboratory study. Setting: University research laboratory. Participants: A total of 20 (12 males and 8 females) healthy, physically active adults. Main Outcome Measures: An isokinetic dynamometer was used to determine isometric peak torque (in N·m). 1RM testing was performed on a knee extension machine. Linear regression was used to develop a prediction equation, and Bland–Altman plots with limits of agreement calculations were used to validate the equation. Results: There was a significant correlation (P < .001, r = .926) between peak torque (283.0 [22.6] N·m) and the knee extension 1RM (69.1 [22.6] kg). The prediction equation overestimated the loads (2.3 [9.1] kg; 95% confidence interval, −15.6 to 20.1 kg). Conclusions: The results show that isometric peak torque values obtained on an isokinetic dynamometer can be used to estimate 1RM values for isotonic knee extension. Although the prediction equation tends to overestimate loads, the relatively wide confidence intervals indicate that results should be viewed with caution.

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Aisha Chen, Sandhya Selvaraj, Vennila Krishnan and Shadnaz Asgari

Accurate and reliable detection of the onset of gait initiation is essential for the correct assessment of gait. Thus, this study was aimed at evaluation of the reliability and accuracy of 3 different center of pressure–based gait onset detection algorithms: A displacement baseline–based algorithm (method 1), a velocity baseline–based algorithm (method 2), and a velocity extrema–based algorithm (method 3). The center of pressure signal was obtained during 10 gait initiation trials from 16 healthy participants and 3 participants with Parkinson’s disease. Intrasession and absolute reliability of each algorithm was assessed using the intraclass correlation coefficient and the coefficient of variation of center of pressure displacement during the postural phase of gait initiation. The accuracy was evaluated using the time error of the detected onset by each algorithm relative to that of visual inspection. The authors’ results revealed that although all 3 algorithms had high to very high intrasession reliabilities in both healthy subjects and subjects with Parkinson’s disease, methods 2 and 3 showed significantly better absolute reliability than method 1 in healthy controls (P = .001). Furthermore, method 2 outperformed the other 2 algorithms in both healthy subjects and subjects with Parkinson’s disease with an overall accuracy of 0.80. Based on these results, the authors recommend using method 2 for accurate and reliable gait onset detection.

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Javad Sarvestan and Zdeněk Svoboda

Background: Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility. Aim: To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions. Methods: Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5–0–5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system. Results: In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5–0–5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests. Conclusion: In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM.

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Kimberly Somers, Dustin Aune, Anthony Horten, James Kim and Julia Rogers

Context: Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy. Objective: The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF. Design: Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05. Setting: A convenience sample study. Participants: A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate. Interventions: Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques. Main Outcome Measures: Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96). Results: Data analysis revealed no significant difference between the 3 groups in all pre–post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7) cm, 0.700 (0.7) cm, and 0.907 (1.4) cm, respectively. Conclusion: Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient’s ability, preference, and response to treatment.

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Guilherme S. Nunes, Débora Faria Wolf, Daniel Augusto dos Santos, Marcos de Noronha and Fábio Viadanna Serrão

Context: People with patellofemoral pain (PFP) present altered lower-limb movements during some activities. Perhaps, joint misalignment in the hip is one of the reasons for altered movement patterns in people with PFP. Some mobilization techniques have been designed to address joint misalignments. Objective: To investigate the acute effects of hip mobilization with movement (MWM) technique on pain and biomechanics during squats and jumps in females with and without PFP. Design: Randomized, placebo-controlled trial. Setting: Movement analysis laboratory. Patients: Fifty-six physically active females (28 with PFP and 28 asymptomatic) were divided into 4 groups: experimental group with PFP, sham group with PFP, experimental group without PFP, and sham group without PFP. Intervention(s): The experimental groups received MWM for the hip, and the sham groups received sham mobilization. Main Outcome Measures: Pain, trunk, and lower-limb kinematics, and hip and knee kinetics during single-leg squats and landings. Results: After the interventions, no difference between groups was found for pain. The PFP experimental group decreased hip internal rotation during squats compared with the PFP sham group (P = .03). There was no other significant difference between PFP groups for kinematic or kinetic outcomes during squats, as well as for any outcome during landings. There was no difference between asymptomatic groups for any of the outcomes in any of the tasks. Conclusions: Hip mobilization was ineffective to reduce pain in people with PFP. Hip MWM may contribute to dynamic lower-limb realignment in females with PFP by decreasing hip internal rotation during squats. Therefore, hip MWM could be potentially useful as a complementary intervention for patients with PFP.

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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.