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Noninstrumented Clinical Assessment of Static Postural Stability in Chronic Ankle Instability: A Systematic Review and Meta-Analysis

Yuta Koshino and Takumi Kobayashi

Context: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used. Objective: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI. Evidence Acquisition: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence. Evidence Synthesis: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, −0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, −0.94; very low certainty evidence). Conclusions: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.

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A Single Bout of On-Ice Training Leads to Increased Interlimb Asymmetry in Competitive Youth Hockey Athletes

Bryce D. Twible, Luca Ruggiero, Chris J. McNeil, and Brian H. Dalton

Interlimb asymmetry (ILA) refers to an anatomical or physiological imbalance between contralateral limbs, which can influence neuromuscular function. Investigating the influence of neuromuscular fatigue on ILA may be critical for optimizing training programs, injury rehabilitation, and sport-specific performance. The purpose of this study was to determine if a single bout of ice hockey-specific exercise creates or exacerbates lower-limb ILA. Before and after an on-ice training session, 33 youth ice-hockey athletes (14.9 [1.7] y; 11 females) performed 3 repetitions of a maximal vertical countermovement jump (CMJ), an eccentric hamstring contraction, and maximal isometric hip adduction and abduction contractions. Force- and power-related variables were analyzed to determine limb-specific neuromuscular function. The on-ice session reduced maximal isometric hip adduction (left: 7.3% [10.3%]; right: 9.5% [9.6%]) and abduction (left: 4.9% [6.9%]; right: 5.0% [8.1%]) force, but did not impair (P ≥ .10) CMJ performance (jump height, relative peak power, braking duration, and total duration). After the on-ice session, ILA was greater for CMJ propulsive impulse (6.3% [2.9%] vs 5.1% [2.6%]), CMJ braking rate of force development (19.3% [7.6%] vs 15.2% [6.4%]), and peak isometric hip adduction force (6.7% [5.5%] vs 6.1% [4.1%]). In conclusion, hockey-specific exercise leads to increased ILA for multiple force-related metrics, which may be a compensatory mechanism to maintain bilateral task performance when fatigued.

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Vision Is Not Required to Elicit Balance Improvements From Beam Walking Practice

Natalie Richer, Steven M. Peterson, and Daniel P. Ferris

Background: Beam walking is a highly studied assessment of walking balance. Recent research has demonstrated that brief intermittent visual rotations and occlusions can increase the efficacy of beam walking practice on subsequent beam walking without visual perturbations. We sought to examine the influence of full vision removal during practice walking on a treadmill-mounted balance beam. Although visual disruptions improved performance of this task, we hypothesized that removing visual feedback completely would lead to less balance improvements than with normal vision due to the specificity of practice. Methods: Twenty healthy young adults trained to walk at a fixed speed on a treadmill-mounted balance beam for 30 min, either with, or without, normal vision. We compared their balance pre-, during, and posttraining by calculating their step-offs per minute and the percentage change in step-offs per minute. Results: Balance improved in both groups after training, with no significant difference in percentage change in step-offs between the normal vision and the no vision participants. On average, the no vision participants had twice as many step-offs per minute as the normal vision group during training. Conclusion: Although previous experiments show that intermittent visual perturbations led to large enhancements of the effectiveness of beam walking training, completely removing visual feedback did not alter training effectiveness compared with normal vision training. It is likely a result of sensory reweighting in the absence of vision, where a greater weight was placed on proprioceptive, cutaneous, and vestibular inputs.

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Effect of External Work Magnitude on Mechanical Efficiency of Sledge Jumping

Keitaro Seki and Heikki Kyröläinen

The mechanical efficiency of human locomotion has been studied extensively. The mechanical efficiency of the whole body occasionally exceeds muscle efficiency during bouncing type gaits. It is thought to occur due to elasticity and stiffness of the tendinomuscular system and neuromuscular functions, especially stretch reflexes. In addition, the lower limb joint kinetics affect mechanical efficiency. We investigated the impact of varying external work on mechanical efficiency and lower limb kinetics during repeated sledge jumping. Fifteen male runners performed sledge jumping for 4 minutes at 3 different sledge inclinations. Lower limb kinematics, ground reaction forces, and expired gases were analyzed. Mechanical efficiency did not differ according to sledge inclination. Mechanical efficiency correlated positively with the positive mechanical work of the knee and hip joints and the negative contribution of the hip joints. Conversely, it correlated negatively with both the positive and negative contributions of the ankle joint. This may be attributable to the greater workload in this study versus previous studies. To achieve greater external work, producing more mechanical energy at the proximal joint and transferring it to the distal joint could be an effective strategy for improving mechanical efficiency because of the greater force-generating capability of distal joint muscles.

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Effect of Mindful Sport Performance Enhancement in College Athletes for Reducing Sports-Caused Anxiety and Improving Self-Awareness: A Critically Appraised Topic

Shivam Garg, Nancy A. Uriegas, Zachary K. Winkelmann, Morgan Adams, and Amy L. Fraley

Mindful Sport Performance Enhancement (MSPE) training is a relatively new concept, which focuses on helping athletes manage a variety of stressors experienced throughout a season, including performing well academically, staying fit, having a productive season in their sport, and maintaining a healthy social life. A need for a critical appraisal is needed to assess the effectiveness of the intervention. Two cohort studies and one randomized control trial were included in the study and assessed using STROBE and PEDro Scale. Key results show, all 3 studies identified participants experiencing benefits after MSPE with aspects of awareness, acceptance, and emotion regulation. Furthermore, student-athletes who attended either all the sessions or more sessions after the 6-week course showed greater satisfaction with mental and physical health. Overall, there is level “B” evidence to support effectiveness of MSPE for college athletes in reducing sport anxiety and improving their overall well-being.

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Erratum. Effect of Mindful Sport Performance Enhancement in College Athletes for Reducing Sports-Caused Anxiety and Improving Self-Awareness: A Critically Appraised Topic

International Journal of Athletic Therapy and Training

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The Prevalence of Hypohydration in School-Sponsored Athletes Across and Within Practice Sessions

Grant G. Yee, Tiffanie M. Nolte, Tyler Z. Bouchard, Courtney M. Meyer, Brendon P. McDermott, Zachery T. Richards, Stephanie A. Rosehart, and Susan W. Yeargin

Hydration status monitoring through weight charts can help active individuals maintain optimal fluid balance and prevent health/performance impairments. This study aimed to determine the prevalence of athletes above an acute hypohydration threshold (within practices), a chronic hypohydration threshold (across practices), and the prevalence of athletes below the acute hypohydration threshold and above the chronic hypohydration threshold simultaneously (e.g., undetected chronic hypohydration). Second, involvement of baseline hydration verification (BV; with/without), sex, and competition level (high school, college/university) with acute hypohydration, chronic hypohydration, and undetected chronic hypohydration were also examined. Undetected chronic hypohydration was prevalent across sexes (6.4 ± 16.7% males; 1.4 ± 5.8% females) and competition levels (6.5 ± 16.4% high school; 5.4 ± 15.6% college/university). No significant differences existed across BV status for average acute hypohydration (with BV = 0.8; without BV = 0.8) or chronic hypohydation (with BV = 0.7; without BV = 0.8). All three calculations, absolute body mass loss, acute hypohydration, and chronic hypohydration, should be utilized to determine the prevalence of hypohydration, and they should also be used to assist athletic trainers while making clinical decisions regarding appropriate rehydration interventions.

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Return to Baseball Following an Anterior Shoulder Dislocation in a High School Baseball Pitcher: A Level 3 Case Report

Maegan M. Milliet, Courtney M. Meyer, Katey Dunham, and Zachary K. Winkelmann

A 17-year-old right-handed high school pitcher sustained a first-time anterior shoulder dislocation. The patient’s imaging revealed a small Hill–Sachs lesion; however, the clinical team’s decision was to manage it nonoperatively. In this case, the patient underwent 7 weeks of rehabilitation, which included general upper extremity strengthening exercises, a modified interval throwing program, and a pitching progression adapted specifically for the patient. After rehabilitation, the patient returned to live pitching with improvements in his pitching statistics. The uniqueness of this case is that it is a less common intervention approach posttreatment.

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Sex Differences and Association Between Modified Balance Error Scoring System Error and Sway Index Scores in Collegiate, Club Sport, and High School Athletes

Ryan N. Moran and Mason Haller

The Modified Balance Error Scoring System (mBESS) remains the standard balance tool for evaluating sport-related concussion. Discrepancies between error and objective sway scoring remain a topic of assessment measures. The purpose was to examine sex differences between error and sway index scores and association between scores on the mBESS in collegiate and high school athletes. 119 athletes completed the mBESS on a Biodex BioSway. Measures consisted of mBESS errors and sway index scores produced by the BioSway. No sex differences were observed on mBESS errors and sway index scores by competition level and the overall sample. Moderate associations were observed between error and sway index scoring for single and tandem stances.

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Stress-Induced Syncope: A Case Study

Alyssa Albrecht

Four adolescent female athletes across four grades were diagnosed with either psychogenic nonepileptic seizures or conversion disorder. The females underwent thorough evaluations with their primary care providers and episode and symptom tracking by their athletic trainer. Through different applications of cognitive behavioral therapy and one-on-one counseling, the disorders resolved. Teaching athletes the importance of choosing healthy coping mechanisms to stress is vital to quality mental health. It is recommended that more research be done on psychogenic nonepileptic seizures and provide an understanding to those working with the adolescent population on triggers and treatments for psychogenic nonepileptic seizures.