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Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of >48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient’s mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B.

Purpose: To determine the acute response of lactate supplementation on athletic performance. Method: Fifteen athletes under the age of 15 performed the following 4 sessions in a nonrandomized order: (1) familiarization, (2) control, (3)  participants ingested calcium lactate (21.5 mg·kg⁻¹ body mass), and (4) participants ingested a placebo (PLA, calcium carbonate, 21.5 mg·kg⁻¹ body mass). The capsules were randomly offered and consumed 60 minutes before the physical tests. To assess the physical performance, the athletes executed squat jump, countermovement squat jump, 20-m linear sprint, change of direction test, and running anaerobic sprint test. Results: There were no significant differences between conditions for squat jump, countermovement jump, change of direction, and minimum power obtained in the running anaerobic sprint test (P > .05). Conversely, we observed a worse performance (P < .05) in the 20-m linear sprint test in the PLA and lactate conditions compared with control (P < .05). The lactate condition worsened performance during running anaerobic sprint test for peak power, mean power, and fatigue index compared with control and PLA (P < .05). Conclusions: Calcium lactate supplementation worsened repetitive running sprint ability and 20-m sprint performance. However, lactate supplementation does not affect jump or agility capacity. Therefore, calcium lactate supplementation seems to be an ineffective strategy to improve anaerobic and neuromuscular performance in soccer players 15 years of age or less.

Background: Hypertension is a significant risk factor for cardiovascular disease, with a higher prevalence among African Americans (AA) than other racial groups. The impact of community-based interventions on managing blood pressure (BP) in AA communities is not fully understood. The purpose of this review was to synthesize literature on community-based physical activity (PA) programs designed to manage BP in AA populations. Methods: We conducted a scoping review by searching 4 databases (PubMed, CINAHL, MEDLINE, and APA PsycInfo) and reference lists of studies. Search terms included community PA, community-based, hypertension, high BP, AA, Black Americans, PA, and exercise. Inclusion criteria were studies (1) conducted in the United States and (2) published in English language from January 2013 to September 2023, with community-based interventions that included PA for BP management among AA aged ≥18 years. Results: Search results yielded 260 studies, of which 11 met the inclusion criteria. BP decreased over time in studies that incorporated PA, faith-based therapeutic lifestyle changes with nutritional education. The duration of the PA interventions varied, with moderate to vigorous PAs implemented for 12 weeks or longer having a greater impact on BP management. Conclusions: Evidence suggests that community-based PA programs can potentially reduce BP among AA. PA programs incorporating faith-based therapeutic lifestyle change with nutritional education appear to reduce BP. Practitioners should consider multicomponent community-based PA initiatives to improve BP outcomes in AA communities.

Background: Primary carers, school teachers, and administrators are key influencers in promoting active lifestyle among children with disabilities (CWD). Guided by the Capability, Opportunity, Motivation, Behavior Model, the Promoting Active Lifestyle among CWD (PALS) Questionnaire aims to determine these influencers’ perceptions, capabilities, opportunities, and motivations in active healthy lifestyle promotion. This study evaluated the content validity and feasibility of the PALS Questionnaire in Filipino and English. Methods: Six experts rated the relevance of the items in the Filipino and English versions of the PALS Questionnaire. Item and scale content validity indices and agreement among raters (modified kappa k*) were computed. The questionnaires were revised and pilot tested among 11 participants comprising primary carers, and special education teachers and administrators using 3 methods of administration: online survey, phone interview, and pen-and-paper survey. Results: Scale-level content validity index indicated excellent content validity (0.96–0.97). Item-level content validity index ranged between 0.67 and 1.00. Interrater agreement on the relevance of all items was excellent (k* = .82–1.00), except for the item on teaching assistants (k* = .56). Most participants found the items easy to understand. The average time needed to complete a questionnaire was 30 minutes. The online version of the questionnaire was identified as the most feasible mode of administration. Conclusion: The PALS Questionnaire is a useful instrument for understanding Filipino primary carers’ and educators’ perceptions on promoting CWD’s active healthy lifestyle. Information from the PALS Questionnaire could inform initiatives toward better CWD health and quality of life.

Purpose: To study whether, during typical-level running, non-rear-foot strikers (non-RFS) or rear-foot strikers (RFS) presented a similar or different extent of neuromuscular fatigue after a prolonged graded run. Methods: Sixteen experienced male trail runners (8 non-RFS and 8 RFS) performed a 2.5-hour treadmill graded running exercise. Before and after exercise, neuromuscular tests were performed to assess neuromuscular fatigue of the plantar flexors. Biomechanical gait parameters were acquired with an instrumented treadmill, and electromyographic activity of the lower-limb muscles was collected as an index of muscle activation. Results: There were no significant time × foot strike interactions for neuromuscular (all P ≥ .742), muscle activation (all P ≥ .157), or biomechanical (all P ≥ .096) variables. Conclusions: A dominant level running foot-strike pattern did not directly affect the extent of neuromuscular fatigue during a prolonged graded run. This suggests that no ideal running foot-strike pattern exists to minimize neuromuscular fatigue during prolonged-duration races wherein cumulative uphill and downhill segments are high, such as in trail running.

Vertical loading rate (VLR) and pelvic floor muscle activity (PFA) increase with running velocity, which may indicate a relationship between VLR and PFA. Foot strike pattern has been shown to influence VLR while running, but little is known about its influence on PFA. Twenty healthy women ran on a treadmill for 2 conditions: with a rearfoot strike and with a forefoot strike. PFA was measured with electromyography. Running kinematics associated with VLR were collected using inertial measurement units and tibial accelerometers. Change scores between conditions were calculated for average PFA and running kinematics: peak vertical tibial acceleration, vertical excursion of the center of mass (VO), and cadence. Paired t tests assessed differences between running conditions for all variables. Pearson correlations assessed the relationships between changes in PFA and running kinematics. PFA was significantly higher during the forefoot compared with the rearfoot strike condition. Change in vertical tibial acceleration was positively correlated with change in PFA during the right stance. Change in cadence was negatively correlated, and change in vertical excursion of the center of mass was positively correlated with change in PFA during left stance. The average PFA increased during the forefoot strike pattern condition. Changes in PFA were correlated with changes in running kinematics associated with VLR.

Background: Tai Chi Chuan (TCC) is considered a mind and body practice of Chinese origin, considered as an intangible cultural heritage of humanity by UNESCO, and recommended by the World Health Organization as a therapeutic approach to prevent falls. Objective: To assess the effects of TCC on older adult’s balance. Methods: A systematic review of randomized clinical trials was conducted by two independent reviewers using the ROB2 tool to assess the risk of bias under the following databases: PubMed, SCOPUS, Web of Science, PEDro, Embase, Cochrane, CINAHL, and LILACS. A meta-analysis of the selected articles for the dynamic and static balance criteria was conducted in a population of older adults (over 65 years) with publications from 2010 to 2024. Results: Eighteen randomized clinical trials fulfilled the criteria. TCC improves dynamic balance in the timed up and go and gait speeds tests, and static balance in the single-leg test and functional reach test when compared with the control group in the meta-analysis. Adverse events were found in only one study, and the training parameters were heterogeneous. Conclusion: TCC improves older adults with both dynamic and static balance. The results of the parameters indicate a direction in which TCC is prescribed for clinical practice with minimal or no risk of adverse effects.

The study analyzed the gaze behavior and decision-making performance of 20 soccer assistant referees while judging offside events. Specifically, gaze behaviors, gaze entropy, and estimated quiet eye (eQE; defined as the last fixation prior to the attacker’s ball pass) characteristics (i.e., location, onset, offset, and duration) were analyzed in relation to decision-making accuracy. Although a significant number of fixations were observed on the offside line, the highest viewing time corresponded to the ball carrier. The gaze behavior indicated a high distribution of fixations, as evidenced by high stationary gaze entropy (>90%). The assistant referees also distinguished offside from onside positions above chance. However, they displayed nonprolonged eQE on the offside line. As a result, no significant relationships were found between the eQE characteristics and decision-making accuracy. The study concludes that the absence of more functional gaze behaviors, specifically with longer eQE focused on the offside line, impaired the decision-making accuracy of nonexpert assistant referees in soccer.