Browse

Purpose: The effectiveness of neuromuscular electrical stimulation hinges on the evoked torque level, which can be attained through either conventional (CONV) or wide-pulse high frequency (WPHF). However, the best electrode placement is still unclear. This study adopted a crossover design to compare the effects of WPHF applied to the tibial nerve trunk (N-WPHF) or muscle (M-WPHF) with CONV in healthy participants. Methods: A total of 30 participants (age: 22.4 [4.5]) were involved in 4 sessions. During each session, participants performed: 2 maximal voluntary contractions, 2 contractions at maximal evoked torque, and 2 contractions at submaximal evoked torque at 20% maximal voluntary contraction. Neuromuscular electrical stimulation intensity-evoked torque, efficiency, and discomfort were measured in maximal and submaximal conditions. Statistical analyses were conducted using a 1-way mixed-model analysis of variance with repeated measures. Results: N-WPHF and M-WPHF showed higher evoked torque than CONV (P = .002 and P = .036) and greater efficiency than CONV for maximal evoked torque (P = .006 and P = .002). N-WPHF induced higher efficiency than M-WPHF and CONV for submaximal evoked torque (P = .004). Higher discomfort was observed for both N-WPHF and M-WPHF for submaximal evoked torque compared with CONV (P = .003 and P < .001). Conclusion: Our results suggest that WPHF applied at either the nerve or muscle could be the best choice for the maximal condition, whereas nerve application is preferred for the submaximal condition.

Context: In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP. Design: Randomized single-blind clinical trial. Methods: Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention. Results: At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001). Conclusion: It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Context: Shoulder impingement syndrome (SIS) is the most common shoulder injury among overhead athletes. The Constant score (CS) is a combined scoring system to evaluate functional status of the shoulder in patients with shoulder pain. Design: Cross-sectional study. Methods: Cultural adaptation of the Persian version of CS was conducted using Beaton’s guideline. Sixty-three overhead athletes (23.57 [7.50] y old) with SIS completed the final version for psychometric assessment. After 5 to 7 days, a group of 33 patients completed the Persian CS again to assess test—retest reliability. Internal consistency, floor/ceiling effects, and item-total correlation were evaluated in patients with SIS. Concurrent validity was assessed through comparison with the disability of the arm, shoulder, and hand questionnaire scores. Twenty-five healthy athletes (31.80 [7.32] y old) participated for determining discriminant validity. Results: The Persian CS demonstrated good test–retest reliability, with subjective and objective intraclass correlation coefficients of .79 and .80, respectively. The internal consistency was satisfactory (Cronbach alpha = .74). No ceiling or floor effects were noted. The Pearson correlation coefficient between CS and disability questionnaire was −.68. The mean total score for patients was 67.02, while for the healthy group was 96.99 (P = .000). The standard error of measurement was 1.51 for patients and 0.7 for healthy group. The smallest detectable change was 16.95 for patients and 5.71 for healthy group. Conclusion: The translation and cross-cultural adaptation of CS into Persian were successful. The Persian version demonstrates sufficient reliability and validity to evaluate shoulder function in overhead athletes with SIS.

Context: This study aims to provide data on the reliability and validity of an adapted Spanish version of the Athlete Psychological Strain Questionnaire (APSQ) when administered to Spanish athletes. Design: A cross-sectional study was developed. Methods: Data were collected from 128 athletes (males n = 71; females n = 57). The tools used in this study were the APSQ; Kessler Psychological Distress Scale; and Depression, Anxiety, and Stress Scales. The intraclass correlation coefficient was used to determine relative reliability, whereas standard error measurement and minimal detectable change were used to evaluate absolute reliability. Bland–Altman plots were employed to assess test–retest agreement and potential systematic bias. Results: Data indicate that the Spanish version of the APSQ demonstrated satisfactory internal consistency (α: .77–.85) and generally fair to good test–retest reliability (intraclass correlation coefficient: .702; 95% CI, .602–.780). Significant associations were found between the APSQ Spanish version and the Depression, Anxiety, and Stress Scales (ρ = .64–.82), with fair to good agreement, whereas fair to moderate levels of agreement were established between the APSQ Spanish version and the Kessler Psychological Distress Scale (ρ = .53–.75). Conclusions: These results provide preliminary evidence supporting the use of the APSQ Spanish version for mental health screening among Spanish athletes. However, the lack of absolute reliability raises concerns about its utility for assessing the effects of interventions aimed at improving mental well-being.

Clinical Scenario: Shoulder pain is the third most common musculoskeletal complaint. The most common type of shoulder pain is subacromial impingement syndrome (SIS). The concept of regional interdependence demonstrates that body regions are interrelated, affecting how they function. Previous studies have reported the influence of the thoracic spine on the shoulder. Clinical Question: Does adding thoracic spine manipulation or mobilization to exercise in adults with SIS improve shoulder range of motion (ROM), pain, and disability? Summary of Key Findings: The literature was searched for level 2 evidence or higher that examined the effects of the addition of thoracic mobilization or manipulation to exercises in shoulder ROM, pain, and disability in SIS. Twenty articles related to the clinical question, but only 3 met the inclusion and exclusion criteria. Two studies reported that the combination of thoracic mobilization or manipulation and exercises resulted in more significant improvements in shoulder ROM, pain, and disability compared to exercises alone. One study concluded that the combination of thoracic or shoulder mobilization to exercises was superior to ultrasound or exercises alone. Clinical Bottom Line: There is moderate evidence to support the addition of thoracic manipulation or mobilization to exercise in treating SIS to improve shoulder ROM, pain, and disability. Strength of Recommendation: Grade B evidence supports a multimodal approach using the combination of thoracic mobilization or manipulation and exercises in adults with SIS.

Context: Traditional assessments of high-order neurocognitive functions are conducted using pen and paper or computer-based tests; this neglects the complex motor actions athletes have to make in team ball sports. Previous research has not explored the combination of neurocognitive functions and motor demands through complex tasks for team ball sport athletes. The primary aim of the present study was to determine the construct validity of agility-based neurocognitive tests of working memory (WM) and inhibition. Methods: Twenty-seven athletes (5 females; mean age 24.2  [4.7] y; height 183.6 [9.1] cm; body mass 77.5 [11.2] kg) participated in the construct validity assessments that included computer-based tests (working memory capacity and stop-signal reaction time) and sport-specific assessments performed on the SpeedCourt system. Results: Construct validity analysis of sport-specific working memory yielded acceptable construct validity (r = .465, P < .05), whereas the sport-specific stop-signal task resulted in low construct validity (r = .179, P > .05). The poor construct validity results highlight the large variance between computer-based and sport-specific neurocognitive assessments. Conclusion: Sport-specific assessments are more complex and include more degrees of freedom potentially due to athletes’ center of mass displacement during task execution. These findings suggest that future research should focus more on the development of sport-specific assessments. These should include the cognitive and motor demands encountered during practice and competition, not use computer-based/pen and paper assessments for return to play decisions.

Context: Chronic low back pain (CLBP) is a common problem among university athletes, negatively affecting their performance and overall health. Deconditioned back muscles due to CLBP can reduce endurance. However, there is limited research on CLBP in university athletes, especially comparing those with and without the condition. Additionally, the connection between back muscle endurance and CLBP in university athletes is unclear, and there is insufficient data on normal levels of back muscle endurance. The present study aimed to establish normal back extensor muscle endurance values in university athletes, both with and without CLBP, and to investigate the link between back extensor endurance and CLBP. Design: Cross-sectional study. Methods: The study included 90 university-level athletes (45 with CLBP and 45 without CLBP; age: 18–30 y). Athletes underwent assessments on demographics, sports, and CLBP-related factors, as well as the Sorensen test. Appropriate statistical tests were applied to the obtained data. Results: Results showed a significant difference (P < .001) in Sorensen test holding duration between athletes with and without CLBP. The correlation analysis revealed a significant association (r = −.79, P = .02) between Sorensen test time and CLBP. Conclusions: University athletes with CLBP exhibit lesser back extensor endurance than those without CLBP. There is a significant association between CLBP and Sorensen test hold time. The study’s implications include using the Sorensen test for CLBP prediction and tracking therapeutic advancements in clinical practice.