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Clinical Scenario: Police, fire, emergency medical services, and military personnel encompass a tactical population practice setting in athletic training. Due to occupational demands within this demographic, these patients experience musculoskeletal or career-altering injuries at an alarming rate. A main contributor to the incidence of musculoskeletal injury is a lack of functional movement. Clinical Question: What parameters of corrective exercise programming improve tactical participants’ functional movement scores on the Functional Movement Screen? Summary of Key Findings: Three studies met the inclusion criteria set forth by the authors. Two studies used an 8-week regimented corrective exercise program while one study used a 4-week corrective exercise program. Two of three corrective exercise programs utilized progressions. All corrective exercise programs noted statistically significant improvements in Pre- and Post-functional Movement Screen scores. Clinical Bottom Line: Functional movement is essential to effective occupational interventions in tactical medicine; therefore, corrective exercise programs should be regimented for a minimum of 4 weeks, 3 days a week to show improvement in functional movement. Available evidence to answer this clinical question met a 2B minimum. Collective findings to answer this clinical question align with letter B strength of recommendation.

Context: There is a well-established increased risk of lower-extremity (LE) musculoskeletal (MSK) injury following a sport-related concussion (SRC). Neuromuscular training programs improve biomechanics associated with LE MSK injury and reduce LE MSK injury incidence, but their relative effectiveness in athletes with history of SRC is unknown. The purpose of this study was to evaluate LE MSK injury incidence in female adolescent athletes with history of SRC following a neuromuscular training intervention. Design: Prospective case-control. Methods: Seventy-seven adolescent female athletes aged 12–18 years who participated in soccer, volleyball, or basketball were recruited from a single institutional sports medicine research and performance center to complete a 6-week neuromuscular training program prior to competitive athletic season. Group (Control, History of SRC) comparisons of athlete exposure and relative LE MSK injury risk and rates during the competitive athletic season were assessed. Results: Ten injuries were recorded by 9 athletes. Female athletes who reported history of SRC had increased injury risk (Risk Ratio 3.9, 95% CI, 1.1–13.8, P = .01) and increased injury rate (rate ratio 4.1, 95% CI, 1.1–15.8, P = .03) compared with female athletes without history of SRC. Conclusions: Female adolescent athletes with history of SRC showed a greater risk of LE MSK injury compared with athletes with no history of SRC. Future work is still needed to understand the underlying mechanisms associated with future LE MSK injury following SRC and interventions that ameliorate elevated injury risk.

Objective: The study aimed to investigate the effects of the level of contraction during isometric shoulder abduction at different abduction angles on muscle thickness and stiffness of the shoulder girdle in asymptomatic individuals. Design: Measurement properties study. Setting: Biomechanics and motion analysis lab. Participants: Twenty individuals volunteered to participate in this study. Main Outcome Measure: The subjects were tested for morphological and mechanical properties, expressed by thickness and stiffness of the supraspinatus tendon and muscle, and upper trapezius muscle. Moreover, acromiohumeral distance was also evaluated using B-mode ultrasound and shear-wave elastography. Intervention: The thickness and stiffness of the supraspinatus and upper trapezius muscle were assessed at 3 angles of abduction (0°, 60°, and 90°) and 3 levels of contraction (0%, 10%, and 20% of the maximal voluntary isometric contraction) using ultrasonography with shear-wave imaging. Moreover, the acromiohumeral distance was measured to establish the occupation ratio during passive movement. Results: The supraspinatus and upper trapezius muscle thickness and stiffness were significantly greater at 60° shoulder abduction compared with 0°, and 90° compared with 60°, as well as significantly greater at 20% maximal voluntary isometric contraction compared with 0% and 10% maximal voluntary isometric contraction. Thickness and stiffness were significantly greater in the supraspinatus compared with the upper trapezius muscle at all 3 angles of shoulder abduction for all 3 level of contractions. The acromiohumeral distance decreased significantly from 0° to 60° and from 60° to 90°. Conclusion: Morphological and mechanical properties of the supraspinatus and upper trapezius muscles depended on the relative level of muscle contraction and the angle of shoulder abduction.

The study aimed to determine differences in sagittal-plane joint biomechanics between athletes with and without knee osteoarthritis (OA) during drop vertical jump 2 years after anterior cruciate ligament reconstruction (ACLR). Forty-one athletes with ACLR completed motion analysis testing during drop vertical jump from 30 cm. Sagittal-plane peak joint angles and moments and joint contributions to total support moment (TSM) were calculated during first landing. Medial compartment knee OA of the reconstructed knee was evaluated using Kellgren–Lawrence scores (ACLR group: Kellgren–Lawrence <2; ACLR-OA group: Kellgren–Lawrence ≥2). The ACLR-OA group (n = 13) had higher hip and lower knee contributions in the surgical limb than the ACLR group and their nonsurgical limb. Further, the ACLR-OA group had higher peak hip extension moment than the ACLR group (P = .024). The ACLR-OA group had significantly lower peak knee extension and ankle plantar flexion moments and TSM (P ≤ .032) than ACLR group. The ACLR-OA group landed with increased hip extension moment, decreased knee extension and ankle plantar flexion moments and TSM, and decreased knee and increased hip contributions to TSM compared with ACLR group. The ACLR-OA group may have adopted movement patterns to decrease knee load and compensated by shifting the load to the hip. Clinicians may incorporate tailored rehabilitation programs that mitigate the decreased knee load to minimize the risk of knee OA after ACLR.

Background: Spiroergometry is important for modern performance diagnostics, and reference values have been evaluated for bicycle and treadmill ergometers. The aim of this study is to assess the comparability of bicycle and hand-crank spiroergometry and its associated parameters, as hand-crank spiroergometry can be used during rehabilitation in patients with definitive or temporally impairment of the lower extremity. Methods: Thirty-seven healthy volunteers completed 2 exhausting performance diagnostics on hand-crank and bicycle spiroergometry. Participants’ anthropometric characteristics, maximum power, multiple exertion criteria, maximum aerobic capacity, and maximum heart rate were detected, and ventilatory and metabolic thresholds were determined. Results: The maximum power, maximum heart rate, maximum aerobic capacity, and ventilatory thresholds were significant higher on the bicycle ergometer (P < .001). The metabolic thresholds occurred on higher lactate values on the hand-crank ergometer. Equations for calculating maximum aerobic capacity from the maximum power measured in either hand-crank or bicycle ergometer could be found through regression analysis. Conclusions: Although there are problems in interpreting results of different ergometries due to severe physiology differences, the equations can be used for patients who are temporally unable to complete the established ergometry due to a deficit in the lower extremity. This could improve training recommendations for patients and para-athletes in particular.

Context: To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. Design: A randomized and controlled clinical study. Methods: Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. Results: The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). Conclusions: The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.